Hello Dr Wisot,
I am about to start my 2nd attempt at ICSI/IVF (my first try resulted in miscarriage at 9 wks). My concern with ICSI is how does the lab know which is the healthy sperm and which is the poor sperm? Out of the millions of sperm are they choosing the best ones? Obviously in normal fertilization it is the better quality sperm that succeeds in fertilizing the egg so I can't help wondering if ICSI could have a negative outcome on the quality of the embryo's. I'm torn about what to do this time around because i'm worried that without ICSI very few, if any, eggs will be fertilized and therefore reducing the chances of success but I don't want to face another miscarriage or no pregnancy at all due to poor quality embryo's again.
Our physician advised us that she recommends ICSI due to a "lower than average" sperm count but that it's not so low that it is a necessity.
Many thanks in advance
Does ICSI affect embryo quality?
Re: Does ICSI affect embryo quality?
Hi:
If you consider that male factor requiring ICSI gives one of the most favorable prognosis for success in IVF it stands to reason that ICSI itself should not appreciably be affecting embryo quality.
But we only think ICSI should be done when we anticipate poor fertilization for the reasons you outline. But poor or no fertilization in an IVF cycle can be a disaster. Without fertilization you have nothing. So if it's your RE's opinion that that's a possibility, then ICSI might be the best alternative.
Good luck.
Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California
If you consider that male factor requiring ICSI gives one of the most favorable prognosis for success in IVF it stands to reason that ICSI itself should not appreciably be affecting embryo quality.
But we only think ICSI should be done when we anticipate poor fertilization for the reasons you outline. But poor or no fertilization in an IVF cycle can be a disaster. Without fertilization you have nothing. So if it's your RE's opinion that that's a possibility, then ICSI might be the best alternative.
Good luck.
Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California
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aglaser
Re: Does ICSI affect embryo quality?
I'd like to follow up with another question about this, if I may.
My husband and I have also been advised to do ICSI, due to a low sperm morphology. However, we too are concerned that this may end up hurting our chances more than helping them. We are clients at your San Diego office, and the forms we were asked to sign note that "On the average,the fertilization rate with ICSI is less than routine IVF so ICSI is not routinely performed on all couples undergoing IVF."
What does this mean? If it really results in a lower fertilization rate, then is the idea of more control over the sperm selection really better? Is it ever worth performing ICSI on some of the eggs and not on others if we are fortunate enough to get a large number?
I also noticed that in your literature you state that "ICSI is sometimes performed the day after egg retrieval, i.e., when fertilization with routine IVF does not occur." Is there a way of planning to do this so that we give the sperm a chance to compete naturally, as it were?
Thanks, in advance!
My husband and I have also been advised to do ICSI, due to a low sperm morphology. However, we too are concerned that this may end up hurting our chances more than helping them. We are clients at your San Diego office, and the forms we were asked to sign note that "On the average,the fertilization rate with ICSI is less than routine IVF so ICSI is not routinely performed on all couples undergoing IVF."
What does this mean? If it really results in a lower fertilization rate, then is the idea of more control over the sperm selection really better? Is it ever worth performing ICSI on some of the eggs and not on others if we are fortunate enough to get a large number?
I also noticed that in your literature you state that "ICSI is sometimes performed the day after egg retrieval, i.e., when fertilization with routine IVF does not occur." Is there a way of planning to do this so that we give the sperm a chance to compete naturally, as it were?
Thanks, in advance!
Re: Does ICSI affect embryo quality?
Hi:
When ICSI is done because of issues in the sperm you would expect to see a lower fertilization rate than when it is not done in couples when the sperm is normal. The lower fertilization rate can occur because of the sperm, not because of the ICSI. The danger is that if you do not do ICSI you will have few or no fertilization.
So-called "rescue ICSI" done the day after retrieval does not work well and should not be the plan. It is sometimes done after the disaster of an unexpected fertilization failure.
Good luck.
Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
When ICSI is done because of issues in the sperm you would expect to see a lower fertilization rate than when it is not done in couples when the sperm is normal. The lower fertilization rate can occur because of the sperm, not because of the ICSI. The danger is that if you do not do ICSI you will have few or no fertilization.
So-called "rescue ICSI" done the day after retrieval does not work well and should not be the plan. It is sometimes done after the disaster of an unexpected fertilization failure.
Good luck.
Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California