To ICSI or Not to ICSI?

During IVF#1, we went in blind, not knowing what the outcome would be for fertilization. The embryologist recommended we fertilize 2/3 of our eggs using ICSI and 1/3 via conventional IVF.

For those of you who aren’t familiar with these terms, conventional IVF is when they place the eggs and sperm together in the Petri dish and let fertilization happen on its own.
This allows the stronger sperm to fertilize, and the normal eggs to be fertilized.

ICSI, which stands for intracytoplasmic sperm injection is when the embryologist selects which sperm he/she deems to be the “the best”, and then manually injects that single sperm into the egg to fertilize it. There is a different kind of selection here, as it is based purely on the embryologist’s observations of morphology and motility. Less natural selection here, as the race to the egg and process of penetrating the zona pellucida (shell of the egg) is bypassed. Potentially, crappy sperm and crappy egg can fertilize and be fertilized by ICSI, however, if you suffer from fertilization failure (hard to penetrate eggs or sperm that can’t dissolve the shell) ICSI can make a positive difference.

These were our results from last year’s IVF:

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Now, the grades of these embryos were all very good, except for one which was fair. The “best looking” embryos were ICSI fertilized. We don’t know which ones were chromosomally normal, but know that the pregnancy (and subsequent miscarriage) in July/August/September was of a chromosomally normal female embryo.

Since egg retrieval is coming up next week, we have to decide how we want to fertilize our eggs. I want last year’s IVF to be a learning opportunity. The embryologist thinks we could do all conventional IVF since we did have fertilization occur properly this way. Conventional IVF also allows natural selection of normal eggs and normal sperm as well. Overall live birth outcomes are the same whether you do IVF or ICSI, even if IVF yields less embryos.

This compares the use of ICSI over Conventional IVF in several different causes of infertility, and finds that ICSI is only beneficial in cases of male factor infertility.

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Right now we’re leaning toward 100% IVF, but our RE thinks we should still do some ICSI, without giving a real reason. He says it depends on our numbers on retrieval day. We are not naive to the fact that doing ICSI means they can charge $1250 more.

And then there’s this, which seems to say that there’s little to no risk from doing ICSI, so why not do it.

Another factor is that we are not using the same anonymous sperm donor as last IVF, so it is unknown how well this sperm will fertilize our new batch of eggs. But seeing as how our sperm is coming from a sperm bank, we can assume the motility counts are decent.

I would love your feedback and experience as we make this decision.

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