I’m not ruling it out, but there’s something that I don’t like about a technician selecting the sperm rather than have them select themselves. I realize that’s silly considering how unnatural the process is in the first place, and in the end it’s all random anyway, but it’s something that I feel pretty strongly about and can’t quite explain.
I haven’t ruled it out, but unless the doctor VERY strongly suggests it, we’re going to go without for the first cycle. If we have total fertilization failure, I would probably reconsider the second time around.
With all due respect if you’re that justifiably worried about putting your wife through this difficult and painful process, why not opt for a procedure that will give you the best possible odds?
This was one of the things we found most ironic about the process. So you want to get pregnant, eh? Ok, take birth control pills. Now, once you get the trigger injection, don’t have sex.
In the middle of our first cycle we called our parents and complained, “This is NOT how you told us babies were made!”
In addition to a support network, a healthy sense of humor is crucial to the process.
We are also just starting, Fiveyearlurker. I’m waiting for my next cycle to start the BCPs. We have secondary infertility, completely unexplained. We’ve been trying for 1.5 years, with timed intercourse and IUIs. I’m 39, so time is very definitely not on our side. Our insurance doesn’t pay for anything, so we’re probably looking at $15k. Our doctor has approved not doing ICSI, but we’re definitely doing assisted hatching and we’re on the fence about PGD.
Just really weird going to the pre-process seminar and seeing how many couples like my wife and I, where both people are relatively young (I’m 31 and my wife 32), were having this problem. If anyone in this thread has any progress (positive or negative), I’d like to hear how you guys are doing.
We have another week to find out if our final IUI worked, but I’m not at all hopeful about it. Then we will take a month off before starting the birth control pills and everything. I think our first actual attempt would be November.
Do you have any major reasons that you aren’t doing ICSI? We’re not doing the PGD because neither of us has any family history of genetic problems. My insurance paid for a full genetic screen and turned up nothing on me. I was happy to find out I was genetically male, which apparently my doctor has had patients learn otherwise.
We’re not doing ICSI because my husband’s counts are basically ok, and we have the same misgivings you do about losing the “selection” effect of natural fertilization. Also, ICSI costs an extra $2200, which is a fair chunk of change to be throwing around if we don’t need to, even if it isn’t a huge fraction of the overall cost. On a purely monetary basis, spending $2200 to potentially save $15000 only makes sense if it reduces the odds of needing another cycle by at least about 15%, and I don’t think ICSI does that for normal sperm counts.
We’ve had genetic screening before we had our first child (who was conceived the old-fashioned way with no problems at all, about four years ago), and neither of us are carriers for anything nasty (well, I have multiple sclerosis, which may have a genetic component, but there’s no test for it). But my age puts us at increased risk of aneuploidy, and we both are a bit phobic about the possibility of Down syndrome. I’m not sure what the total cost is for PGD - the clinic hasn’t quoted that for us.
I’ve pulled the numbers from primary literature actually. As long as the postwash total sperm count is above 1 million, the possibility of total failure of fertilization doesn’t change. It’s about 20 percent whether your number is a million or 300 million. Once fertilization occurs the odds of an ICSI embryo implanting is identical to a traditional IVF embryo. There was an article recently stating that there is some degree of upselling to ICSI among fertility clinics to couples where it is not likely to help at all.
Wow, that’s higher than I would have guessed. Does ICSI always “work” (actually fertilize the eggs)? Has anyone reported the chances of viable embryos on day 3 with and without it for couples with adequate counts?
(Sorry to completely freeload on your research. I can tell you about the chances of different protocols triggering an MS flare, but it’s probably not relevant.)
I haven’t looked at the rates for ICSI. My understanding is that it helps bring the fertilization rate in couples where the man has inadequate counts up to the rates of normal couples with standard IVF. In other words, if your husband has adequate counts, there isn’t much reason to do it, unless there have been past failures with standard IVF that would indicate another problem. I hope that makes sense. There is also a chance that ICSI will destroy an otherwise viable egg.
It only becomes complicated in cases like mine where the counts are low, but not so low that ICSI is the only option. Like when they are taking sperm by biopsy directly out of the testicle, and only have a few to work with. Then ICSI is clearly indicated.
But, yeah, fertilization can actually fail with ICSI as well. Strange as it would seem that actually putting the sperm inside the egg wouldn’t work! But, remember that not every sperm has the capacity to fertilize and not every egg can be fertilized. So, that more than likely accounts for the failures.
I just found some papers that address the numbers in a little more depth, but I can only access the full papers from my work computer, so I’ll take a look tomorrow. There isn’t a whole lot of data because ICSI is typically for male factor, as would make sense.
I’ve just been looking at the numbers comparing whether I’ve got as good a shot as a normal couple despite my lower swimmers.
Here is a relevant paper though that basically shows that if there is a history of fertilization failure, that ICSI is a superior option to avoid it in the future. But, that doesn’t do much to figure out if you would be in that group that failed before trying.
One of the references from that paper shows that the pregnancy rate is not measurably different with and without ICSI when sperm counts are normal, though. It’s a 10-year-old paper, and techniques have undoubtedly improved, but I doubt they’ve improved enough to get up to a 15% difference.
I also found this article about “borderline semen,” which may be of interest to you if you haven’t seen it yet.
I am literally just about to walk out the door to work, but send me a PM if you’d like. I’m currently undergoing IVF (PGD, actually, for genetic challenges), and I am also a former embryologist that worked for several years in an IVF clinic. Several years before becoming an embryologist I worked as an andrologist and know much, much more about sperm that I would have expected to learn in a lifetime.
Either PM me or send me an email (it’s in my profile.) I’d be more than happy to answer any questions you have or share my experiences.