As much as I complain about the exorbitant expense of IVF there was one “add-on” that I really wished that my doctor would suggest. In our IVF class they talked about ICSI and the improved success rates for some patients. Our doctor did not think it was necessary for us, but at the time I wanted to do anything possible to improve our chances. I did a little remedial research and what exactly the procedure is and although I thought it couldn’t hurt, my doctor ultimately decided that it was just not something that we needed to spend the extra money on.
ICSI is an acronym for intracytoplasmic sperm injection. Put simply it is the process of fertilizing retrieved eggs by injecting selected sperm directly into the egg with a needle. To be honest, I don’t know much more than that about the specifics of the procedure but to me it seems that a skilled embryologist might have a better chance of coercing those sperm to do what they need to do than the more traditional method of allowing the sperm and egg to self select and fertilize at will. In fact, research has shown that fertilization rates are improved with the use of ICSI in certain patients.
ICSI is recommended primarily to couples with severe male factor infertility, those who have had a failed cycle or low fertilization rates, or those who have few eggs retrieved (5-6 are considered low). The theory is that with fewer eggs ICSI gives the patient a better chance of ensuring fertilization of the most eggs possible. We did not meet the criteria for any of the above – it was our first cycle, male factor was not our issue, and they retrieved 23 eggs. 11 of our eggs fertilized, although only 4 made it to the blastocyst stage. I did wonder if we would have had more freeze options if we had used ICSI, but our results validated the doctor’s decision to not use ICSI.
I guess my take on it now is that if ICSI is recommended to you look at it as a good thing – a procedure to give you the best opportunity at success. However, if the doctor does not think it is necessary for you and your unique situation try not to second-guess him or her and trust that he is doing what is best for you. There are pros and cons to both and a lot of doctors are now performing ICSI as a standard practice on half the eggs and utilizing standard procedures on the other half. Like many other things in the world of infertility only time and research will tell whether or not ICSI becomes an even more widespread technique – and I am sure you are like me, I don’t really care how it is done as long as one way or the other finally works!
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