Why don't they always do ICSI?

[Dexy007]

Hi everyone

We have male factor infertility (amongst other things) so we were told from the outset we would need ICSI. I'm currently in the middle of my very first ever round of IVF and I've deliberately tried not to go down the rabbit hole of research, forums, blogs, etc (I am already an overthinker and worrier!)

But one thing I've gathered is that ICSI has a much higher success rate (not of implantation and ultimate pregnancy, but of getting to embryos fertilised at least.

So why do clinics not just do it as standard? What am i missing?

Dexy

It costs more (for NHS if funded or for the individual if private) as it takes more time for the embryologist to select and inject the sperm, and from what I've read this has a higher drop off rate in any fertilised embryos due to potential issues with the sperm that aren't visible microscopically. Sperm that have found and penetrated the egg in the petri-dish the traditional IVF way are in theory less likely to have potential abnormalities as they've done what nature intended and got there first so are mobile, morphologically correct etc.

I'll be starting an IVF round of ICSI myself in August, I hope yours is successful! :)

They have to be sure the potential benefits outweigh the risks

There can be a damage rate when performing ISCI, although it's low under 5% but can be higher depending on egg quality

It bypasses natural fertilisation so a sperm could be selected that may not have otherwise fertilised an egg

Thanks this makes sense...but I thought they picked the best sperm? Like they choose the healthiest / best ones to inject. No?

They do choose the healthiest based on what they can see, but depending on reason for MFI there are factors like dna fragmentation and chromosomal issues with the sperm which they can't see without another procedure on the sperm. Some couples have sperm surgically removed to counteract this and I've read lots of forums of people getting a bfp after surgical sperm removal when they weren't getting any 5 day blastocysts from the ejaculated sperm.

The odds are overall still good though, and it really depends on the cause of MFI, which isn't always known. In my case my husband has a varicocele which can't be embolized so everything is very low in his results, and the embryologist has advised him to only have a one day abstinence before providing a sample for fertilisation to try and avoid morphological issues and higher chance of dna damaged sperm rather than the usual 3 to 7 days.

We had a 50/50 IVF/ICSI split - so half the eggs had ICSI and half standard IVF. No known male factors but we were advised to do a split purely because we had been trying for 4 years and all other fertility treatments never worked. Our standard IVF lot made better quality and more blasts than the ICSI ones 🤷🏼‍♀️🤷🏼‍♀️ Weird as I thought it would be the other way around!

@EmzieMurf1987 that seems to be quite common, the fertilisation rate for ICSI is better but the drop off rate for the embryo is worse than traditional IVF, usually get less blastocysts at 5 days. I hope to get plenty of eggs to try and improve those odds at least but staying realistic about it, plus it only takes one :)

Embryos that decline from day 3 are usually due to sperm quality which I guess ties in with people having ICSI due to MFI so the drop off makes sense for ICSI v IVF

We did ICSI , we were private and it cost another £1,000 , in the grand scheme of things not fortunes.
But we also did PGT-A and of the 14 eggs that fertilised and made it to day 5 only 4 were (euploid) genetically normal so there was quite a big drop off at that point.

Hi hun. It is my understanding that it really depends on the clinic and their statistics. In the States, some clinics recommend ICSI for those without male factor infertility. There is an additional cost, so this may deter some. Here is a great article which summarizes ICSI. www.mamasconnected.com/post/icsi-intracytoplasmic-sperm-injection-ivf-in-vitro-fertilization-infertility
Best of luck to you x