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11-14-2012 at 10:07 PM
jschwind22
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ICSI or not?

Hi ladies!

My clinic automatically does 100% ICSI, unless we direct them not to.  What are the pros and cons for using ICSI or not?  Is there any reason not to?  We have MFI, so I'm guessing ICSI is the way to go for us, but I just want to make sure I'm not missing something.  TIA!
My Chart
May 3T Siggy Challenge- Dream Vacation- Italy
May TTGP Siggy Challenge- Superheros

TTC #1 since February 2011
Me: 29 (high NK cells diagnosed 3/5/13)
DH: 28 (MFI low morph and motility diagnosed 5/8/12).
RE is recommending IVF but we want to start with IUI. DH was unwilling to pursue treatment until 7/21/12.
Cycle #21- Injects + IUI #1= BFFN
Cycle #22- HSG 9/21/12 all clear= BFFN
Cycle #23- Injects + IUI#2= BFFN
Cycle #24- IVF #1- ER 12/6/12 (14R, 11M, 9F), ET 12/9/12 transferred 2 day 3 embies
Beta #1 10dp3dt=3 (-). Beta #2 12dp3dt=6.6 (+). Beta #3 39.1 (+)
Bleeding and low betas=very cautious Image and video hosting by TinyPic C/P 5W3D
Cycle #26- Diagnosed high NK cells 3/5/13. FET scheduled 3/20/13- CANCELLED- lining issues
Cycle #27- Starting Trental for 3 months for new FET protocol. Natural cycles until FET in August
PAIF/SAIF/ALL Welcome! 
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11-14-2012 at 10:21 PM
aprilbeach...
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From my research and what our RE has told us, ICSI is usually always done when there is MFI involved. MFI was not an issue for us (we are just "Unexplained") and our RE still recommended it to give us the best possible chance since we don't know what is causing our issues.  Our doctor said there are really no drawbacks to doing ICSI (aside from the additional cost).  It's totally up to you as the patient, though, you can let the sperm do what they do and let nature take its course, or you can go the ICSI route and let the Embryologist choose the best sperm to implant into the best egg. 

Me (34) DH (33) TTC #1 since 09/2003 Dx: Unexplained IF

12/10 Clomid + IUI #1 - BFN; 2/11 Clomid + IUI #2 - BFN; 5/11 Clomid + IUI #3 - BFN; 8/11 Injectables + TI - BFN; 10/11 Injectables + IUI - BFN

IVF #1 planned for November 2012

My Bio (work in progress) My Blog  
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11-14-2012 at 11:29 PM
Mayzie15
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We have severe MFI so we will always use ICSI when doing IVF.  If you have MFI, most clinics will suggest you do ICSI - helps your chances during fertilization but usually adds an extra cost.  Good luck with your decision!
Me 37 MH 40 - TTC since June 2010 - dx with Severe MFI. Straight to IVF with ICSI. IVF #1 - ER 06/13/12 - 9 Eggs Retrieved - 4 ICSI'd - only 2 fert. 06/15/12 - 2DT - 3 cell & 6 cell with fragmentation. Beta 06/29/12 - IVF #1 = BFN. 07/20/12 - WTF Appt -Told by our RE to quit IVF. Second Opinion from RE is good. IVF#2 - November 2012. Estradiol Pills Started 11/6. Stims start 11/16. ER 11/26 - 7 eggs retrieved - all mature. 4 fertilized with ICSI. ET 11/29 Transferred 3 embryos. Beta is 12/10. 1st Beta 81 2nd Beta 160 and 3rd beta 360!!! First U/S 12/21/12 - We saw one beautiful gest. sac. 2nd U/S is 01/04/2013 - H/B 183 02/05/13 - NT Scan - everything looks good and IT'S A BOY!!! EDD 08/19/12
"Everything will be okay in the end. If it's not okay, it's not the end."

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11-15-2012 at 6:42 AM
eandk18
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I'm not sure if there are any cons but we are definately doing ICSI.  We are unexplained and the doctor said 98% of the time they fertilize on their own and 2% they don't.  I know it's only 2% but I don't want to chance it!

TTC since 3/2009
DH: Normal
Me: High prolactin/mild PCOS/irregular cycles
Dec 2012: IVF- Antagonist/Ganirelix protocol due to OHSS risk
ER: 12/4- 14 R, 13 M, 7 F
ET: 12/9- 2 blasts transferred, 2 frozen
BETA: BFP! 12/18-Beta #1-290, 12/21-Beta #2-over 1100 Beta#3 >10,000
IT'S TWINS
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11-15-2012 at 6:47 AM
brooklynes...
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If you have MFI I think ICSI is pretty standard.  My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding.  Apparently there's evidence of a higher rate of birth defects with ICSI.
Me: 39. DH: 41. TTC since 2009.
FSH: 9.5 at highest. AMH (11/2011): 0.9. AFC: 10ish. HSG: Normal. SA: Normal.
July 2011 - Feb. 2012: 2 Clomid/TI cycles; 3 injectables/IUI cycles. Good response but BFNs.
Dec. 2011: Laparoscopy (clear) + hysteroscopy to remove uterine polyp.

April 2012: IVF #1: FSH 9.2, AFC 7-8. Antagonist protocol.
Started stims (300iu Gonal-F, 150iu Menopur) 3/28.
Added ganirelix 4/1. Trigger 4/5 (7 follies). ER 4/7: 7R, 0M, 0F. :-(

Nov. 2012: IVF #2: Long Lupron protocol.
Started Lupron 10/27. AFC 10+. Started stims (300iu Follistim, 150iu Menopur) 11/8.
Trigger 11/18 (7 follies). ER 11/20: 9R, 1M, 1F. 3dt of my one 6-cell embie on 11/23: BFN.

Dec. 2012: Hail Mary IUI cycle with leftover IVF meds: BFN.

Feb. 2013: IVF #3: Estrogen priming protocol.
Pre-AF: estro patch + ganirelix. AFC 8-10. Started stims (450 Follistim, 150 Menopur) 1/28.
Added ganirelix 2/4. Combined Lupron/HCG trigger 2/10 (6-ish follies).
ET 2/12: 6R, 1M, 1F w/rescue ICSI. My embie didn't make it. :-(

July 2013: DE IVF #1

PAIF/SAIF/PA35 welcome.
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11-15-2012 at 7:22 AM
precious72...
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My husband does not have MFI but due to low motility we did ICSI our first round. This cycle we were able to do them naturally. Same amount fertilized for us. The only thing I have read that you may want to ask about is that the little hole they put into the egg gives it a slight advantage to splitting, twins! I don't know the percentage or if it is really an issue, especially if you have MFI and have to do it so it doesn't matter. Both with ICSI and natural my doc put two back so guess he isn't too worried about me having a litter. GL!!!
Me = 31 husband = 35 Married 6/27/2009 TTC since 8/2010 (off BCP since 8/2009)
Unexplained Infertility,I'm a Hemocromotons mild carrier, also have single mild copy of MTHFR
6/2010 FSH 7.2 4/2013 FSH 8.6 AMH 1.4
I have primary lymphedema in my right leg which as far as I know, is not affecting my IF but not many studies out there.
7/2011 Natural cycle with 25mg clomid BFN
8/2011,1/2012,3/2012 IUI #1-3 25-100mg clomid BFN
6/2012 IVF#1 9ER 5 fertilized 2ET ICSI & assisted hatching BFN
8/2012 IVF#2 FET 2ET BFN
11/2012 IVF#3 7ER 5 fertilized naturally!!!! My hubby can fertilize my eggs :) 11/11 2ET 2 of 5 embryos made it to 5dt
11/19/2012 8dp5dt BFP beta 53 p4 7, PIO shots started ,11/21 beta 138 p4 29! 11/26 beta 698 11/29 beta 1942 12/3 beta 6640
12/10/2012 U/S #1 6w4d - One little baby with heartbeat of 124bpm :)edd 8/1/13
12/26/2012 U/S #2 8w6d - No heartbeat,only measured 6 weeks, dx missed miscarriage
12/28/2012 D&C
1/17/2013 Chromosome testing came back as normal male :(
1/19/2013 RPL testing normal
4/3/2013 SIS showed asherman's syndrome caused by D&C (scar tissue)
4/4/2013 Hysteroscopy to remove scar tissue
June 2013 IVF planned
5/12/2013 SURPRISE BFP! Natural cycle 12dpo beta 93 progesterone 43 5/20/2013 15 dpo Beta #2 466!!! Progesterone 57 5/22/2013 Beta #3 *****ALL WELCOMED*****
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11-15-2012 at 7:37 AM
MrsGlitter...
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My H doesn't have any sperm issues, the issues were all me. All 6 of my eggs were fertilized with ICSI and we ended up transferring 2 and freezing 3. With it giving you a better chance, I don't see why you wouldn't do it.

TTC since October 2008My Infertility History is listed in my Blog
My Blog
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11-15-2012 at 7:42 AM
jschwind22
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brooklynesque:
If you have MFI I think ICSI is pretty standard.  My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding.  Apparently there's evidence of a higher rate of birth defects with ICSI.

Do you know of any studies regarding this statement about birth defects?  The packet that we have to sign acknowledges a slightly higher risk of chromosomal abnormalities leading to miscarriage, but nothing about actual birth defects.  Thanks. 
My Chart
May 3T Siggy Challenge- Dream Vacation- Italy
May TTGP Siggy Challenge- Superheros

TTC #1 since February 2011
Me: 29 (high NK cells diagnosed 3/5/13)
DH: 28 (MFI low morph and motility diagnosed 5/8/12).
RE is recommending IVF but we want to start with IUI. DH was unwilling to pursue treatment until 7/21/12.
Cycle #21- Injects + IUI #1= BFFN
Cycle #22- HSG 9/21/12 all clear= BFFN
Cycle #23- Injects + IUI#2= BFFN
Cycle #24- IVF #1- ER 12/6/12 (14R, 11M, 9F), ET 12/9/12 transferred 2 day 3 embies
Beta #1 10dp3dt=3 (-). Beta #2 12dp3dt=6.6 (+). Beta #3 39.1 (+)
Bleeding and low betas=very cautious Image and video hosting by TinyPic C/P 5W3D
Cycle #26- Diagnosed high NK cells 3/5/13. FET scheduled 3/20/13- CANCELLED- lining issues
Cycle #27- Starting Trental for 3 months for new FET protocol. Natural cycles until FET in August
PAIF/SAIF/ALL Welcome! 
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11-15-2012 at 8:07 AM
BeckyP005
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jschwind22:

brooklynesque:
If you have MFI I think ICSI is pretty standard.  My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding.  Apparently there's evidence of a higher rate of birth defects with ICSI.

Do you know of any studies regarding this statement about birth defects?  The packet that we have to sign acknowledges a slightly higher risk of chromosomal abnormalities leading to miscarriage, but nothing about actual birth defects.  Thanks. 

Wow I didn't know this. Can't remember if the DE coordinator mentioned this as we will be doing ICSI.
ME:44 MH:42 DE IVF 2013
Matrix Ollie
 
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11-15-2012 at 8:55 AM
Love4Labs3...
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Like other people said, I've heard there is a slightly higher rate of abnormalities and a higher chance of splitting.  I don't have any research to back that up, it's just what I've heard.  With out MFI, I would definitely do ICSI.
230737_2003784652243_5215174_n
Mr. & Mrs. since March 26, 2011
TTC #1 since May 2011 ~ Everyone Welcome
ME(29) ~ DOR due to chemo and radiation, FNH, Hypothyroid
Ewing's Sarcoma ~ 9/30/92 ~ CURED!!!
DH(29) ~ Oligoasthenoteratozoospermia, Low testosterone
7.5 million spermies on ice!
IVF/ICSI/AH planned for June 2013
Vivelle, Progesterone, HGH, Dexamethasone
Femara, Bravelle, Menopur, Ganirelix

 
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11-15-2012 at 9:00 AM
ball.and.c...
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jschwind22:

brooklynesque:
If you have MFI I think ICSI is pretty standard.  My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding.  Apparently there's evidence of a higher rate of birth defects with ICSI.

Do you know of any studies regarding this statement about birth defects?  The packet that we have to sign acknowledges a slightly higher risk of chromosomal abnormalities leading to miscarriage, but nothing about actual birth defects.  Thanks. 

This might be helpful:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424218/

Also, this paper indicates that there is no improvement in clinical outcomes when using ICSI in non-MFI patients:

http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/Intracytoplasmic_sperm.pdf

ETA: MFI isn't an issue for us (we used donor sperm) and we did not do ICSI (our RE was going to do it for us only if the sperm quality was poor after thawing).  But since OP has an MFI diagnosis, I do think it sounds like the right thing to do.
Married my wife 8/2007 *** TTC #1 since 7/2011
4 IUIs w/ midwives = 4 BFNs
5 IUIs w/ an RE = 5 BFNs
IVF October/November 2012
ER 11/1: 22 eggs retrieved, 17 fertilized!
ET 11/6: 1 blast transferred, 5 frozen
BFP 11/15! Beta #1: 104 Beta #2: 613 Beta #3: 3415
Blighted ovum discovered at 7w5d; D&E 12/13
FET 1 cancelled
FET 1.1: ET 4/30: 1 blast transferred
BFP 5/7! Beta #1: 142 Beta #2: 730 Beta #3: 3100
*Everyone welcome*

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11-15-2012 at 9:15 AM
faithhopel...
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We had MFI and our RE recommended ISCI right away with IVF, it cost more than just doing IVF it was an additional $1000 for us at our clinic. But from all the research that I did in this area ISCI is what you want to do for MFI and increases your chances since they choose the very best swimmers and put them right into the egg to fertilize!
BabyFruit Ticker Me (30) DH (31)
Been with DH for 6 years
Married 6/11
Began TTC 8/11
5/12 DH DX with MFI - low everything
6/12 Met with RE and Urologist - Unexplained MFI
8/12 Began 1st IVF/ICSI
9/2/12 ER - 25 eggs, 4 frosties, 2 transferred
9/10/12 Beta #1 = 4, 9/12/2012 Beta #2 - 8, Beta #3 - 5 = Chemical Pregnancy - BFN
10/12 moving on with FET
11/1/12 - Embryo Transfer (2 embies transferred)
11/12/12 (11 dpt) Beta #1 - 674 - BFP
11/14/12 (13 dpt) Beta #2 - 1699  
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11-15-2012 at 9:27 AM
JSM0801
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I just recently had this whole discussion with my dr. We are MFI as well and did ICSI. We had great embryos for the first three days, and then they started slowing down by day five. From what i have gathered, it seems that although ICSI is an amazing process, where the embryologists are choosing the sperm that looks perfect, they might not actually be good sperm. They can only use human eye, but they can't see inside the sperm to know if there are any abnormalities or dna fragmentation. So what often happens in cases of MFI is that they pick sperm that look good and will fertilize the egg, but then they are not healthy enough to continue growing into a good embryo. With natural IVF, it is survival of the fittest, so the best and healthiest sperm will naturally fertilize the egg. However, you are risking the chance of none or very few fertilizing, especially with MFI. There are pros and cons to both, but most likely if you are MFI, your best bet is ICSI. GL
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Me (33)- unexplained MH (35)- MFI due to Vericocele. Straight to IVF w/ICSI 9/12, Antagonist = BFN c/p, poor quality blasts, tested sperm dna fragmentation. Results all good, yay! New RE for IVF #2- 1/13., Long Lupron. ER on 1/22 -10R, 9M, 9F. Transfer on hold due to overstimming. FET in Feb. 2 frozen blasts. Another BFN & another c/p. RPL testing all negative besides MTHFR gene, vericocle repair surgery 4/12/13-Bilateral Grade 3 Vericocele found & fixed, IVF #3 with PGS 4/13- 11R, 9M, 9F. Transferred 2 normal=BFN, 3 normal on ice Everyone Welcome!!!
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11-15-2012 at 10:53 AM
WindyCity3...
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We're MFI and will be doing ICSI. We're also weighing the pros and cons of assited hatching

The Best Darn BLOG on the bump...I kid, but seriously!
Unmedicated and medicated IUI's: all fail IVF #1: Dec 2012 26r/16m/15f 12/9: 5dt of 2 beautiful blasts and 5 frosties TWINS! 3/9: 15w4d Baby A PProm 3/9-3/22: Hoping and Praying like never before. Bedrest and pure hell 3/22: Baby A cord prolapse 3/25: 2 baby boys born sleeping Currently: Doing my best to pick up the pieces and find hope.
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11-15-2012 at 11:14 AM
Crystal120...
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We have no MFI issues, in fact my RE always is impressed with his swimmers. Dh is always a show off even when he's not trying lol. Anywho, there wasnt really a option with us, it's part of our package. Our RE thinks it helps the chances but I guess its really just a matter of opinion. Good luck!!
Married 9-10-11
Together 6 years before marriage
Me 26 DH 28
TTC since 9/2011
Dx endo 2007 Sx laparoscopy
End bcp 9/2011
Dx annovulatory, DOR, Low AMH
Hysteroscopy due to polyp 2-1-12
IUI#1-3 Cancelled due to low response
IUI#4 BFFN
IVF#1 8/30 Beta#1 256, 8/31 Beta#2 482 BFP!! M/C 5w3d
FET#1 Cancelled due to uterine fluid and thin lining
FET#1.2Cancelled due to abnormal bleeding
Hysteroscopy 12/28/12 All clear
FET#1.3 2/2013 Cancelled
FET #1.4 3/19 BFFN
Good Luck to All!!
Crystal
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11-15-2012 at 11:36 AM
Scoop77
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We decided not to do it, but we're not MFI. They told us at the clinic that there was a slightly higher rate of some birth defects but that they're not sure whether the higher risk comes from the fact that often the couples who are doing ICSI are MFI and naturally have a higher rate of sperm that will cause those birth defects anyway, even if they were naturally fertilizing. They said they're not sure whether it's MFI that causes the increased risk of birth defects or the the ICSI process. We fertilized fine without ICSI, but if we had MFI, I would do it in a heartbeat. GL either way!

TTC #1 for about 3.5 years
ME: 37, PCO, immune issues?, teflon uterus (my added diagnosis)
HIM: 38, Perfect. (Showoff.)
Month before starting Clomid, spontaneous pregnancy. m/c at 7 weeks and D&C.
Four months of Clomid, one IUI, with Intralipid each cycle: BFNs all
IVF 1.0 July 2012 -- Lupron, bravelle, menopur, estrogen, progesterone supps, intralipid. 14 ER, 14 fertilized, 1 blast transferred, 2 on ice. BFN
FET 1.1 -- 10/2, transferred our 2 blasts. Lupron, PIO, estrogen, baby aspirin, prednisone. BFN.
IVF 2.0 December 2012 -- Bravelle, Menopur, Ganirelix, Prednisone, Metformin, estrogen, progesterone supps. 22 eggs retrieved on 12/14, 17 mature, 15 fertilized. OHSS anticipated so ET cancelled. 3 embryos frozen.
Broke up with old RE. Moving on to new dude. Maybe the change of scenery will be just the trick for our frosties. On BCPs for possible April FET.

P/SAIF welcome 
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11-15-2012 at 11:56 AM
diamante11...
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If I remember correctly, if its a 2% chance for non-IF, it is like a 3-4% chance for IVF with or without ICSI.
Me: 31, PCOS (insulin resistance) TTC since 05/11. DH: 31 Great SA after multivitamins and diet improvements 6/25 IUI #1 cancelled IVF #1 w/ICSI on 8/23 CANCELLED due to ovulation. IVF #1.2 BFN 11/6 3 snowbabies. FET #1 12/20. Beta 12/31-BFFN FET #2 scheduled for 6/12. Everyone WELCOME!!  
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11-15-2012 at 8:27 PM
jschwind22
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Thank you ladies for your feedback!  I think the answer is obvious with the MFI diagnosis- do ICSI.  If we didn't have MFI, I would maybe consider doing 1/2 with ICSI and 1/2 without, if there were enough eggs. Good luck everyone!
My Chart
May 3T Siggy Challenge- Dream Vacation- Italy
May TTGP Siggy Challenge- Superheros

TTC #1 since February 2011
Me: 29 (high NK cells diagnosed 3/5/13)
DH: 28 (MFI low morph and motility diagnosed 5/8/12).
RE is recommending IVF but we want to start with IUI. DH was unwilling to pursue treatment until 7/21/12.
Cycle #21- Injects + IUI #1= BFFN
Cycle #22- HSG 9/21/12 all clear= BFFN
Cycle #23- Injects + IUI#2= BFFN
Cycle #24- IVF #1- ER 12/6/12 (14R, 11M, 9F), ET 12/9/12 transferred 2 day 3 embies
Beta #1 10dp3dt=3 (-). Beta #2 12dp3dt=6.6 (+). Beta #3 39.1 (+)
Bleeding and low betas=very cautious Image and video hosting by TinyPic C/P 5W3D
Cycle #26- Diagnosed high NK cells 3/5/13. FET scheduled 3/20/13- CANCELLED- lining issues
Cycle #27- Starting Trental for 3 months for new FET protocol. Natural cycles until FET in August
PAIF/SAIF/ALL Welcome! 
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11-16-2012 at 7:49 AM
rrdiva1
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jschwind22:
Thank you ladies for your feedback!  I think the answer is obvious with the MFI diagnosis- do ICSI.  If we didn't have MFI, I would maybe consider doing 1/2 with ICSI and 1/2 without, if there were enough eggs. Good luck everyone!

Hey you, sorry all late to the party! It looks like you made your decision, but yes with MFI ICSI is the way to go! Better chances! ((((hugs))))
Married BF 6/29/2002/ TTC Since Aug 2011/ ME:34 all clear/DH:41 DX Severe MFI/ IVF w/ICSI OCT 2012 Stims started 10/8/ER 10/19/12/ET 10/24/Beta#1 11/2=BFN (beta was 1.2) IVF 2.0-Baseline 11/7/12 beta 0/All Clear Stim start 11/7/12//ER 11/19 11M//10F ET 2 embies 11/24//Beta#1 28 Beta #2 23 Beta#3 29 stop meds Beta#4 37/C/P 5W5D EDD:8/12/13/IVF#3 in Jan Antagonist protacol again Everyone welcome!! My Chart//> Image and video hosting by TinyPic
 
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11-17-2012 at 9:45 AM
new+tothis
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brooklynesque:
If you have MFI I think ICSI is pretty standard.  My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding.  Apparently there's evidence of a higher rate of birth defects with ICSI.

This is what my clinic does too. They recommend doing ICSI for all MFI including antibodies or DNA fragmentation. I think (but I'm not positive) that they recommend it if you've had a previous IVF cycle without success or with low fertilization rates. 

TTC #1 for Dh, #2 for me. HSG clear. Low AMH and endo. Multiple Clomid w/TI cycles - all BFNs. 2 IUIs with Clomid and 1 with Femara - more BFNs. IVF#1 25R, 15M, 15F. 5DT of two perfect 4AA blasts! Positive HPT at 5dp5dt. Beta #1 6dp5dt - 72. Beta #2 8dp5dt - 285. Beta #3 10dp5dt - 793. Both babies have strong beautiful heartbeats! Baby B miscarried at 7 weeks. Baby A is holding on through miscarrying her twin, sub-chorionic hematoma, and complete placenta previa. Stick, baby, stick!

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