ICSI process and time scale.

[mabel92]

Hello,
My husband and I are most likely going to have to go through ICSI due to male infertility.
I’m struggling to find answers that I understand - can anyone tell me the process of ICSI and the time scale? I’ve been told that I would need a antagonistic protocol due to high AMH and then a frozen transfer.

Thank you in advance!

Once your clinic is ready to start you will probably start stim injections on day 2 or 3 of your period for about 10 days (depending on how you respond) then you will be booked for egg collection. I am guessing your clinic is concerned your high AMH will lead to OHSS which can be serious so to avoid that they will put any fertilised embryos in the freezer and wait about 2 natural cycles for your body to calm down. You can then start the process for a frozen transfer which depending on your clinics protocol can take about 6-8 weeks so you are probably looking at about 3 or 4 months before transfer and then it is two weeks from transfer to pregnancy test.

Timescales for ICSI are same as IVF the only difference is how the egg is fertilised but the rest of the process is the same.

Good luck!!

Thank you so much for your reply. That’s the best information I’ve received. So Is the frozen transfer quite simple after my body calms down? Does the 6 - 8 weeks include the wait or is the 6-8 for the actual transfer? If I was starting in February then realistically if all goes well then it would be around April/May before transfer. I live very far away fro my clinic so there are lots of logistics to figure out. Sorry for all the questions! Have you gone through ICSI yourself?

Hi, I think the exact protocols vary between clinics. I had ICSI antagonist protocol with norethisterone. So day 14 of cycle started norethisterone tablets taken for 10 days. This was followed by a bleed 5 days after stopping the norethisterone (although timing of bleed will vary from person to person). The next day had a scan and was started on stims which were taken for 12 days with blood test/ scan monitoring every 2-3 days. Egg collection took place 3 days after stopping stims. So from start to finish it took about 5 weeks which is much longer than I had expected.

I believe clinics usually like to wait for 1-2 natural cycles before starting frozen a transfer. Again the timescale really depends on which protocol they use. We are on long protocol so start medication for down regulation (basically switches everything off) day 21 of period lasting about 2 weeks followed by a scan. After scan started oestrogen patches to build uterine lining up adding on progesterone a week before transfer. This section took 20 days. So again from start to finish about 5 weeks.

But there are so many variations of both and length of time it takes also depends on your response. Eg. Some people need longer for stims so their follicles are the correct size, some need longer for oestrogen to get the uterine lining thick enough. There are also different protocols for FET such as short protocol (I believe it’s similar to the long but with no down regulation) and natural cycle where embryo transfer is timed with when you ovulate naturally with no drugs. Our consultant told us long protocol frozen transfer is a bit old fashioned now and he is only sticking with it as it was successful once before.

Good luck! X

Thank you @Lemongrass1 is it rude to ask why you went for ICSI? Completely understand if you don’t want to tell me.
Do they decide your medication at your first appointment? We have an appointment on Monday for my husbands follow up SA and then hopefully get on the road for ICSI, although if it’s as bad as his first then we have to wait a further month for tests etc it’s such a waiting game and that’s what gets me the most! I’m always massively preparing myself that it most likely won’t work.

To be honest it wasn’t so much as a choice as what the clinic decided. They felt it had better success rates for fertilisation than IVF alone. OHs SA was ok as far as I’m aware. At the consultant appt they just said we were having ICSI but no other details. I think they did decide on the protocol at that time but we weren’t given info on this until the coordination appointment. I was so clueless at the time that just went along with it all! Didn’t discover these forums until part way through the cycle which have been a wealth of info. I found the first hospital appt was a bit information overload and it’s hard to process it all at the beginning. If they’d had talked to me about protocols at first appt prob would have gone in one ear and out the other. But if they do decide to proceed with ICSI maybe ask them then which protocol they are putting you on and if they have a info leaflet so you have an idea of the process. The waiting really does suck doesn’t it? But hopefully you will be on your way soon.

For me I had ICSI and then a FET due to OHSS.

The timeline was something along the lines of:

Once all initial appointments, blood testing and screening done in jan/Feb we started actual treatment in April

Early April injecting daily to suppress ovulation etc. Scans to check all ok. Then started injections to stimulation egg production alongside precious injection so two a day. Scans to check follicle growth and size. Had about 4 scans. Then egg collection collection early May. I had a low ish AMH of 11. Had 14 eggs collected but my estrogen levels were through the roof so was told we would have to freeze all due to high risk OHSS. Out of 14 collected 5 made it to 5 day blastocysts for freezing.
We then had a month and a bit break to allow recovery from OHSS and hormones settle down. Then started taking estrogen tablets on first day of cycle to thicken lining in preparation for fet. Had a few scans. Lining wasn’t thick enough so increased the tablets and included estrogen patches. Lining then thick enough. Had embryo transfer on 18th July. First one didn’t survive the thaw on the day so had to freeze another. OTD was 31st July and it was positive! I’m currently 27 weeks pregnant.

At the time I was dissapointed about the FET but now I’m so glad we waited I was in no fit state after egg collection where as with the FET I was excited and ready to go. I really think the positive mind set helped.

Wishing you lots of luck

Second the PP about a break between egg collection and ET. Had a fresh transfer and it was a disaster. Was on the cusp of overstimulating and they were considering whether they could proceed. In hindsight would have been better to do freeze all. Frozen transfer was a much better experience than the fresh for me.