ICSI vs Natural Fertilization (Unexplained IF)


#1

I am currently undergoing my first IVF cycle after almost three years of TTC. DH is perfect and the only known issues with me are irregular cycles. Sometime I have a 28 day cycle and sometimes it’s closer to 35 days but everything else is fine (so far).

After six IUI’s (five failed and one chemical pregnancy) here we are doing IVF. As far as I know, the chemical pregnancy in November was my only BFP ever.

I had 13 eggs retrieved yesterday and my RE decided to do half natural fertilization and half ICSI so this would not be a wasted cycle if no eggs fertilized. All six of the eggs fertilized naturally, but of the seven ICSI, only three fertilized normally. Of the remaining four, three were ruled degenerative and one fertilized abnormally. :confused:

I’m concerned the six naturally fertilized will arrest because if it were that easy, why wouldn’t I have gotten pregnant yet? I’m driving myself crazy (aren’t we all :eek:) so please keep your :cross: we end up with a few good embabies to transfer!

Does anyone have any thoughts or incite into this topic? Thank you for reading. :grouphug:


#2

Jen I’ll definitely be praying for you. I truly hope you have a few great embryos to transfer! Best wishes. I’ll be looking out for your updates.


#3

I don’t have any stories or advice, but wish you all the best! I’ve enjoyed reading about your journey while I sit out with these pesky cysts :slight_smile:

My clinic also wanted to do half and half, but I think we’re just going to do all of them “au naturale” because my husband has a really high count (borderline morph at 10%). Did they recommend the ICSI because of your IUI history? I heard that it’s usually for male factor, but your husband sounds fine. Just wondering why they recommended it in the first place as we make this decision ourselves.


#4

Hi Jen

I just had my IVF orientation and we also decided to do half ICSI because my hubby morph is only 2% and the other half natural. The RE told me that there is a higher pregnancy rate for those fertilized au natural. They way I look at it is natural selection, the only way they could fertilize is if all parameters where normal. Where as ICSI we are forcing it, and are selected based only on visual inspection. But by selecting good looking swimmers does not guarantee that it is chromosomal ok. I’m glad you and hope you transfer goes smoothe and we will be hewing good news soon!!!


#5

My clinic wouldn’t even recommend ICSI where there is not male factor issues. In my case there was no choice since my husband’s sperm had antisperm antibodies and thus wouldn’t penetrate the egg so they had to be placed inside so the egg would dissolve the antibodies and allow for fertilization.

As far as I can tell there seem to be some eggs that like natural fertilization and some that like ICSI. That may be why your Doc wanted to try half and half since it is your first IVF he may have just wanted to see which category yours did best in. Seems you are ones that like the natural process since that worked best here.

Who knows why the IUI’s didn’t work. I think it is a good sign that all 6 of them fertilized naturally with the IVF though. Clearly they like each other and have some chemistry. Don’t over-think why the IUI’s didn’t work. This is a whole new cycle with very different factors so…I think it is a good sign!

:cross: and :babydust: :babydust: !!


#6

I also had 50/50 this cycle, and 2 natural ones fertilized fine, and 2 out of 3 fertilized with ICSI. My RE was recommending all natural from the beginning based on the analyses of the sperm, which is not that superb. But, looks like it’s good enough to do its job naturally. I have to agree with above ladies that natural fertilization is better as it’s egg’s selection of healthiest and better fitting sperm. There are a lot of chemical matching that the two have to have, ICSI does not offer it.
And I also failed 2 IUIs, none can explain it.


#7

[QUOTE=JenPritch]I am currently undergoing my first IVF cycle after almost three years of TTC. DH is perfect and the only known issues with me are irregular cycles. Sometime I have a 28 day cycle and sometimes it’s closer to 35 days but everything else is fine (so far).

After six IUI’s (five failed and one chemical pregnancy) here we are doing IVF. As far as I know, the chemical pregnancy in November was my only BFP ever.

I had 13 eggs retrieved yesterday and my RE decided to do half natural fertilization and half ICSI so this would not be a wasted cycle if no eggs fertilized. All six of the eggs fertilized naturally, but of the seven ICSI, only three fertilized normally. Of the remaining four, three were ruled degenerative and one fertilized abnormally. :confused:

I’m concerned the six naturally fertilized will arrest because if it were that easy, why wouldn’t I have gotten pregnant yet? I’m driving myself crazy (aren’t we all :eek:) so please keep your :cross: we end up with a few good embabies to transfer!

Does anyone have any thoughts or incite into this topic? Thank you for reading. :grouphug:[/QUOTE]

JenPritch, it doesn’t sound like anything is abnormal with your cycle so far. I think you just got lucky with the 6 naturally fertilized embryos. ICSI should usually be just as good as natural, if not better, and the doctor may have chosen this protocol to inform any future cycles you might have. Sometimes, a man’s sperm can appear mostly normal but have DNA decondensation issues which can increase failed fertilization rate and the chance of miscarriage. If the ICSI would have given more fertilizations and the natural fertilizations few, it may have been an indication that there were sperm issues.

I don’t know all of the information your doctor may have given you, but from everything you’ve mentioned, I doubt that the 6 naturally fertilized embryos will arrest. After all, if you had so many failed IUI’s, it suggests you have some sort of tubal issues which prevent sperm from getting to the eggs. If that’s the case, its not an egg or sperm issue that is preventing you from conceiving naturally but a tubal issue (perhaps a blockage?), so your IVF attempts should proceed pretty smoothly.


#8

[SIZE=3][FONT=Calibri]Hello everyone I have to ask a question. I’ve been reading everyone’s feedback regarding ICSI. I’d like to know why everyone’s opinion is different; against ICSI.[/FONT][/SIZE]
[SIZE=3][FONT=Calibri] My DH sperm is excellent. BUT my RE or should I say IVF Coordinator suggested we do ICSI. She states it has a better fertilization rate. My understanding is the embryologist will review the sperm and pick one of the best looking sperm to penetrate one single egg. The IVF Coordinator also stated that rules out any sperm abnormalities. As we’ll know only one sperm penetrated the egg. The IVF Coordinator also informed us that ICSI can [I]sometimes ([/I]most likely rare[I]) [/I]cause harm / fragmentation but that’s a risk we’d be taking. [/FONT][/SIZE]
[SIZE=3][FONT=Calibri]So again can you please explain why you are against ICSI? Our IVF is coming up next month and I want to make sure we are making an educated decision. [/FONT][/SIZE]


#9

[quote=Webelieveinmiracles][SIZE=3][FONT=Calibri]Hello everyone I have to ask a question. I’ve been reading everyone’s feedback regarding ICSI. I’d like to know why everyone’s opinion is different; against ICSI.[/FONT][/SIZE]
[SIZE=3][FONT=Calibri] My DH sperm is excellent. BUT my RE or should I say IVF Coordinator suggested we do ICSI. She states it has a better fertilization rate. My understanding is the embryologist will review the sperm and pick one of the best looking sperm to penetrate one single egg. The IVF Coordinator also stated that rules out any sperm abnormalities. As we’ll know only one sperm penetrated the egg. The IVF Coordinator also informed us that ICSI can [I]sometimes ([/I]most likely rare[I]) [/I]cause harm / fragmentation but that’s a risk we’d be taking. [/FONT][/SIZE]
[SIZE=3][FONT=Calibri]So again can you please explain why you are against ICSI? Our IVF is coming up next month and I want to make sure we are making an educated decision. [/FONT][/SIZE][/quote]

I have the same questions. My RE only does ICSI - he doesnt do natural fert for some reason. Plus he uses only frozen sperm. Which I also dont get why.

JenPritch - Hope your embies grow to blasts! I dont know much about this thats why my questions too.


#10

I have great insurance from MA that covers IVF, but they won’t cover ICSI unless there are two consecutive SAs that show male factor infertility. I’m just starting my first IVF and my RE said she can do “rescue ICSI” on day 1 if there isn’t any natural fertilization.

I too have a bit of discomfort about forcing the sperm to meet the egg if they wouldn’t naturally, but if fert turns out to be our problem then we’ll probably go for it. ICSI also seems to be much more commonplace these days (for most insurers, my RE will ask automatically for ICSI but they know from experience that mine won’t cover it).


#11

I can provide my opinion based on my limited experience. We have had to use ICSI due to my husband’s sperm. Last cycle, we did not have any eggs fertilize but I was able to speak to the embryologist quite a bit. In his opinion, ICSI is an excellent choice when it appears that natural will not work (ie: we did not have enough sperm in the sample AND they were not really moving too well so they did not think it would work with natural). However, the embryologist stated that he only goes by the appearance of the sperm that he selects and that is not necessarily the best one but just the one that he decides looks the best. With natural, the best one usually wins because it’s the strongest, best swimmer and in his opinion that usually indicates a better sperm all together. However for some of us, we rely on the embryologist to make that care and pray for the best! I would think this is why maybe JenPritch that all your natural are doing better?! Sending prayers up for embabies!


#12

From my personal experience… ICSI works wonderfully!! My DH has low morphology so we decided to go with it and 11 of my 12 eggs fertilized in our fresh cycle, we transferred 2 and 6 were frozen on day 5… and we have one perfect, healthy almost 2-year old daughter from that fresh cycle and I’m pregnant with twin boys from an FET using the embryos from our fresh cycle. I’m almost 30 weeks preggo and both boys look perfect and healthy via ultrasound! ICSI works!!! But I think it might depend on the embryologist/lab at the clinic you go to… and their success rates!


#13

Judging by all of the scientific literature I’ve read on ICSI, it is almost always better than natural fertilization. The caveat? It’s more expensive because you are adding an additional procedure. However, ICSI is not uniformly beneficial for everyone. A man with perfect sperm will not benefit at all from ICSI. A man with problematic sperm will benefit greatly. Also, if you haven’t run the full rang eof genetic tests on a man’s sperm, ICSI might still be used as a precautionary measure in case something MIGHT be wrong with the sperm. This tends to be especially true in cases of “unexplained infertility.”

There is a minute probability that ICSI might produce generational issues because ICSI is inadvertently “directing the hand of evolution,” replacing natural selection amongst sperm with artificial selection. But hey, we’re all doing IVF so we’re basically doing that anyway.


#14

First off, I truly appreciate all of the feedback that has been provided. Even if there are different views, I love hearing all sides so that an informed decision can be made in the future (for me and anyone else who stumbles upon this thread).

All tests on DH’s sperm have been excellent so there has been no indications at all of a sperm issue. I believe the half/half decision was based on our history of failed IUI’s and three years of trying so this would not be a wasted cycle. My RE does not do rescue ICSI.

The nurse seemed very pleased about the six naturally fertilized eggs and didn’t seem as excited about ICSI for some reason.

Ahnny, I’m trying to take your advice and not over-think everything because there is nothing I can do at this point except pray!!

Webelieve, did they give you any reason why they would do all ICSI with good sperm? If my naturals embies grow to blast, I’d be researching about doing a half/half cycle. Only time will tell if my opinion changes though.

Suma, I find it interesting that your clinic only does ICSI and only uses frozen sperm. I;m not saying this is wrong and I’m sure there’s reasoning behind it…just makes me wish we could read their minds and understand why things are done so differently at each clinic.

I will get an update tomorrow morning as I have been scheduled for a 3dt at 11:30. The nurse said it will probably be bumped to a 5dt on Sunday as long as they grow so please :pray: we have good growth for all my embies!!

Thank you all so much for the good thoughts being sent my way!! :grouphug:


#15

Hi Jenn and all,

Chiming in here since DH and I are firmly in the ICSI crew. It does make me a little nervous to “play god” with this important step when we are already interferring with nature so much in this process: eliminating the natural selection element does seem to have its disadvantages. But in our case it’s the only way.

However, one of the reasons I feel so confident in our clinic is that they do over 80% ICSI these days regardless of MF or not. They say the fertilization rates are better. I’ve read mixed reviews online about whether live birth rates are in turn better, but if my RE didn’t believe they were I’m sure they wouldn’t be doing so many ICSIs.

I’ve read the skill of your embryologist matters quite a bit in the ICSI process, so I at least feel better knowng our team does this all the time.

Also, I believe the ICSI process is relatively new in the past handful of years, so there is probably still a lot to learn about pros and cons.

Can’t wait to hear how this turns out for you Jenn - it’s quality not quantity, right? 6 natural embies sounds like a great start!

:babydust:


#16

[QUOTE=JenPritch]First off, I truly appreciate all of the feedback that has been provided. Even if there are different views, I love hearing all sides so that an informed decision can be made in the future (for me and anyone else who stumbles upon this thread).

All tests on DH’s sperm have been excellent so there has been no indications at all of a sperm issue. I believe the half/half decision was based on our history of failed IUI’s and three years of trying so this would not be a wasted cycle. My RE does not do rescue ICSI.

The nurse seemed very pleased about the six naturally fertilized eggs and didn’t seem as excited about ICSI for some reason.

Ahnny, I’m trying to take your advice and not over-think everything because there is nothing I can do at this point except pray!!

Webelieve, did they give you any reason why they would do all ICSI with good sperm? If my naturals embies grow to blast, I’d be researching about doing a half/half cycle. Only time will tell if my opinion changes though.

Suma, I find it interesting that your clinic only does ICSI and only uses frozen sperm. I;m not saying this is wrong and I’m sure there’s reasoning behind it…just makes me wish we could read their minds and understand why things are done so differently at each clinic.

I will get an update tomorrow morning as I have been scheduled for a 3dt at 11:30. The nurse said it will probably be bumped to a 5dt on Sunday as long as they grow so please :pray: we have good growth for all my embies!!

Thank you all so much for the good thoughts being sent my way!! :grouphug:[/QUOTE]

Jen, there is a good chance that they didn’t actually do all of the possible sperm analysis tests. Did they do the Male Reproductive Health Panel? It can cost upwards of a thousand dollars but it will actually examine whether a man’s sperm has chromosome decondensation issues. Most men undergoing IVF are not offered the test at all, since it is very new. However, it’s estimated that many, many unexplained causes of fertility is actually male factor involving chromosome decondensation.


#17

Demian, I’m pretty sure they never checked that panel on DH. If this doesn’t work out for us, I will be asking for it though.

I just got the call that we have been bumped to a 5 day transfer on Sunday!! I have to wait for someone else to call later today for an update on my embies though. I will update when I can for those following along with my journey. :flower:


#18

I just spoke with our RE this morning about this. He said he not only goes by studies done around the world but he also tracks and studies every case he does and he has seen much better results with natural fertilization. He only uses ICSI when there is a male factor. He will do rescue ICSI but letting the fertilization happen naturally, the strongest/best sperm wins. You are not relying on “human” intervention. Where one person may pick what they “think” is the best, in natural fert, the true best one wins. He has also seen a dramatic increase in implantation rates with natural.

In my case, I’ve had two successful pregnancies. First one conceived naturally, second through IUI. My husband’s latest semen analysis was great so he sees no reason to mess with nature. But we were approved (due to my age and other factors) for rescue ICSI.

The bottom line is, you have to trust your RE to do the best thing for your situation. I’m happy I’m at an office that does offer both and doesn’t force us into one or the other.

HTH, and praying you have some awesome blasts for transfer.


#19

Jen - Good luck on Sunday! A 5dt seems very promising. Stay hopeful!


#20

So far all nine embies are growing! Here’s the breakdown:

one 6 cell with 5% fragmentation
one 7 cell with 5% frag.
six 8 cell with no fragmentation except 1 has 5% frag.
one 12 cell not sure about fragmentation because they think it’s growing too quickly and will not turn out good

Ideally, 8 cell is perfect but there is a good chance the 6 and 7 cell will catch up and turn out fine. They are all great quality as you can see from the fragmentation numbers.

I forgot to ask which ones were natural vs ICSI but will make sure I ask on Sunday when I go in for transfer.

They also agreed to let me switch over to Endometrin instead of the PIO shots so overall it’s a great day!!

Thank you all for you good vibes/thoughts/prayers and please keep them coming!! :flower: