Sorry to hear about your stressful cycle.
Why aren't you happy doing ICSI?
What reason does your clinic give for this test? (I.e. What is the evidence of benefit?)
Yes you could move clinics but better to explore why they think this bacteria will cause a problem.
Good luck

I think in your shoes I would get a second opinion from another clinic.
I would have a low threshold for ICSI assuming you have unexplained infertility (or any element of male factor) though.
You don't want to waste any eggs with failed fertilisation...

Jonathon, I had ruled out ICSI also and was given the option of traditional ivf or ICSI. At my next appointment they told me that ICSI was all they are doing now and we had no choice. Long story short is that they said they'd honour our decision if we wanted trad Ivf. I ruled it out for the same reason as yourself and then ruled it back in as I don't want to be in this same position this time next year.
I think with the ICSI they will strip down your DH sperm so the bacteria will be removed?

There is no evidence at all that ICSI gives an increased chance of abnormalities for babies. None at all.


In fact, in most clinics, success rates with male factor cases (using ICSI) can be slightly higher than for IVF, but that is more to do with the additional complexities in getting and sustaining a pregnancy with female factor issues, but it really does show there isn't a connection with ICSI and abnormalities.

Have they offered him antibiotics?

You can also do something called PICSI, which is where the clinic puts the sperm into a dish where one part of it is coated with the hormone given off by a freshly-released egg
They watch which sperm swim towards it, and select those to do the ICSI, as it points to which ones are naturally more likely to have swum towards the egg.

The other option is IMSI, where they use a very very high powered microscope to select the sperm based on a number of factors.

Also bear in mind that there is plenty of 'natural selection' taking place with the fertilisation process, and then again as the embryos grow. Only around 20-25% of eggs will make end up as fertilised blastocysts, which shows how much the process weeds out abnormal eggs, sperm and embryos.

My consultant informs me there is evidence, abnormality risk doubles from 3% to 6% with abnormalities to kidneys and eyes being the main ones.

There really is no conclusive data to say ICSI increases the risks of abnormalities... either in base studies or meta analysis

gamblers i would be really interested to see the study your consultant referred to because I can't find it

There is a little bit of evidence to suggest IVF pregnancies have a higher rate of abnormalities compare to natural conception.

If you are genuinely worried, it might be worth doing a sperm DNA defragmentation test which will tell you what % of sperm have normal DNA. If it is within normal parameters, then there is no reason ICSI wouldn't work especially if you want to combine it with IMSI or PICSI

Check the price list and website of your clinic - they'll list it if they offer it.
I think the Lister is the only place that has the IMSI microscope but I could be wrong. PICSI is fairly widely offered as an add-on for about £350

It would also be worth speaking to the embryologist about your concerns and they can talk you through how the ICSI process works

OP, you said the NHS website says there is a warning about ICSI risk?
I can only find this story which says a study found that ICSI pregnancies have lower level of complications than IVF pregnancies

www.nhs.uk/news/2014/01January/Pages/Risks-of-infertility-treatments-overhyped.aspx

I suppose I'm only trusting what he's telling me as there's lots of conflicting information and he has access to more information than we will ever have. We only know of the current published research whereas he'll be party to so much more.
Ivf should have no greater risk of abnormalities as the sperm and egg meet in the same fashion.
It's a total minefield and as much as I try to put it to the back of my mind I'm the same as OP, will I be able to cope with always thinking did I cause X abnormalities to happen just for my need to have a baby.
I guess we all have our individual worries about the process, this is mine.

I'm happy to explain a bit more about the main theories on why there are more abnormalities with IVF than natural conceptions if you want, but don't want to worry you if you'd rather not know...

But for the sake of anyone stumbling across this thread in the future, I really want to put to bed the idea that there are added risks from ICSI...

A fertility consultant really won't have access to lots more information. Very few (I only know of one) clinics will track patients beyond a confirmed clinical pregnancy (when they see a heartbeat on ultrasound) so simply won't know the outcome of the birth.

Some clinics will try and track live birth data, but that is by writing to patients and asking them to confirm if they have had a live birth. It won't account for a live birth with abnormalities, nor is there any mechanism in the HFEA follow ups to track this.

The only way this can be done is from studies, and then any meta analysis of the studies. These have all shown that there is no statistically significant risk from ICSI over IVF

There is some evidence to show sons born to fathers with sperm problems may inherit the same sperm problems, and you can argue this is a risk from ICSI, because those sons wouldn't otherwise have inherited their father's faulty sperm gene if they hadn't been born

But this isn't relevant to the OP, because ICSI isn't being proposed as a way of overcoming male factor infertility, just to wash the sperm and remove the bad bacteria

Spare change, it's hard to say put across in text without being rude as I in no way mean to be rude

Are you medically trained/working within medical / fertility profession, as you seem to have different info as to what we have been given by our specialists which does lead me to wonder who to trust. I will always trust the info from the specialist unless I feel more knowledgable about something or if I've got a second opinion else where.

I work in the medical world and there are often invites to certain conferences where we are privy to more information than is published.

Agreed not the purpose of OP post the ICSI thing just interested me as I've had this dilemma myself and couldn't find a thread on it.

We did ICSI for male factor (plus pcos) to get DD so I'm biased.
My understanding is that there is a 2% increase in risk of abnormalities as quoted above but that the mechanism is unknown.
It is worth remembering that abnormalities covers a huge range of conditions (so an extra toe or a birthmark would all count as well as big things like a missing kidney!)
ICSI improves fertilisation rates dramatically.
We had no children and no chance of pregnancy without ICSI. We have no regrets, so I am biased.
I am not sure that you can class anything natural about ivf though, sorry.

(I'm a consultant obstetrician)

Nano, agreed. Clutching at some straws!
That's more like what my consultant had said however claimed 3% more but still more.
I imagine we will go with ICSI, we were 100% no then we were changeable as time went on and then I read this thread and it reminded me of my initial feelings.
The moral of that story, stop reading!

Hi,
just to add to what nano said, what is reported is an increase in risk with ICSI. So if average risk of birth deformities for pregnancy is 2%, Increase in risk of 3% means an actual total risk now is 2.06%. Which is actually a smaller increase then it initially seems. I calculated these as we have MFI and our consultant thought we might have to go for ICSI. Totally up to each person what they decide to do in the end, but sometimes the numbers sound scarier then they are once you work out absolute risk. Of course, age, family history, etc might effect your personal risk, and even a small increase might be too much for you personally. There are so many decisions to make with this process, i just want anyone reading to have all the info.