How do embryologists choose the sperm for ICSI

[theotherfossilsister]

This might be a really daft question but I can't actually find an answer and it's really worrying me that we won't get the best/fastest swimming/strongest sperm.

We are having ICSI for make factor in the autumn. Dp had terrible psoriasis which I think is attacking his sperm too. How do we know the best sperm will be chosen though?

I am super interested in this too! Like, what about DNA fragmentation? Do they check for that? Because I read that can cause cells to fail to develop to good blastocysts (so if you can find out beforehand, why wouldn't you?!).

@AnonymousXXIX yes, I think we would have to go private to test for that though, which seems to make no sense.

I'm 36 next month as well so it's not like we have time for lots of cycles.

I don't think you can do dna frag on individual sperm. My DH has a v low count (less than 1m per ml) and we were told doing a frag test wasn't possible on that lower a count.

I think they look for normal shapes and strong swimmer. there's some explaination here: www.mcrmfertility.com/treatment-options/in-vitro-fertilization-ivf/sperm-selection/#:~:text=Intracytoplasmic%20Sperm%20Injection%20(ICSI)%20Process&text=The%20remaining%20specimen%20of%20%E2%80%9Chealthy,using%20a%20fine%20glass%20needle.

For the record despite the poor count and less than 1% normal forms 5/6 of my last round fertilised and we ended up with 3 top quality, pgs blasts. so i doubt DNA frag does much

Thank you @Bells3032, that's fantastic. I'm so happy you have blastocysts. Are they in the freezer now?

Yep three from First round in the freezed. We just got our results from our second round Retrival yesterday (we are embryo banking atm) out of 5 mature 4 have fertilised normally.

Whilst the dna fragmentation may make the difference bbetween needing ivf and icsi I think when using icsi it doesn't make much difference

DNA fragmentation is a separate test - they can't use the sperm they have tested for this to then fertilise an egg

Basically ICSI relies on the experience of the embryologist - it's very subjective - they look through a microscope at the sperm sample and simply choose the one they think is the best - generally the most active, normal looking one, swimming in the right direction (sounds silly but some do swim backwards!)

@bells3032 that sounds brilliant, I'd never heard of embryo banking before but it sounds like a great idea. How wonderful it would be to have lots of good embryos and for one or two to turn into a baby/babies.

Thank you @ivfbeenbusy - is there any way they can know the sperm's not fragmented just by looking at it? I've seen your posts before and so happy for you about your baby twins. Was yours icsi?

@theotherfossilsister i don't seem to find clinics are massively keen on doing it. not sure why. It's a very expensive and resource intensive insurance plan. Given that my AMH is very low but my quality still seems excellent and that my DH's meds are making his blood pressure high (so we don't want him staying on them long term) and that we aren't desperate for a baby just yet (we started early due to knowing these issues in advance) it just seemed like the right thing for us. However, if i get pregnant first time both times it would have cost us about 20k in total for the extra eggs we didn't need.

I also did embryo banking over a 3 cycle package

No they can't tell dna fragmentation levels from just a visual inspection of the sperm - much like our dna isn't visible

Yea I had twins from ICSI x

@theotherfossilsister

The embryologist can not tell by looking at the sperm if it has severe DNA fragmentation, which is one of the unofficial reasons why miscarriage rates are higher among ICSI cycles.

There is the option of PICSI which is just ICSI but with a much more powerful microscope, that will help somewhat although not 100% foolproof either.

onlinelibrary.wiley.com/doi/10.1111/andr.12982

However the traditional sperm concentration technique is the swim-up method followed by density gradient centrifugation. The latter 'density gradient centrifugation' has some objections because it does seem to 'stress' the sperm out a bit in unofficial terms.

Maybe see if they offer 'Magnetic-Activated Cell Sorting' which is a better way to remove dying sperm from the sample and has been around for a few years now, otherwise there is a couple other newer methods available (Microfluidic sperm selection / Double Tube method) that they may be able to do for you if the Consultant agrees its a big risk.

Hope this helps a little.