IUI vs IVF vs ICSI ???

[SD2001]

I don't know much about ICSI or IUI - we went straight to IVF and as there's no issue with DH's sperm, ICSI wasn't even discussed.

Hi Buliej,

Is your clinic in Melbourne?

SD

[buliej]

Yes - Melb IVF...note that we discussed IUI with my FS but agreed that given my age, the best move for us was to go right to IVF...basically, I asked if she (my FS) were in my shoes at my age, what would she do and she said IVF.

[SD2001]

Hi Buliej,

It is interesting that your FS suggested IVF. My clinic would most probably have suggested ICSI.

[buliej]

SD2001 - there are no problems with DH's sperm or fertilization, thus we really don't need ICSI at this point.

[Kahlan]

Hi,

Just thought I join the discussion. As DH has sperm issue we went directly to ICSI, however not without trying to see if IUI or IVF could be done. They tried to "clean his sperm" to rid it of the antisperm antibodies but to no success.

Honestly when we came to term with having to go down the path of assisted conception I have given up any notion of natural selection. There is no natural selection in terms of which eggs is fertilised by which sperm (remember in natural selection the bulk of the sperm is killed prior reaching the uterus anyway whether they are good ones or bad) and not every egg gets fertilised (we produce approximately 400 eggs in our entire life but.. well a person might have a max of 10 - 15 kids in a life time. So I don't care whether it is IUI, IVF or even ICSI. To me they are all the same and truthful... at this point I don't care if it is not natural selection.. I just want a baby.. what is more morally troubling for me is the frosties I still have... I don't think I have the heart to destroy them....I think we might attempt with all frosties... and if that means we have a house full of kids.. well that would be a blessing.

To answer your question about seeing "quality" under the microscope.. well when it comes to sperm, bad ones could certainly be seen because they are "deformed" in some way. That's is how they find out how infertile a man is.

[SD2001]

Hi Kahlan,

Welcome to the discussion.

As DH has sperm issue we went directly to ICSI

Yes, ICSI has been a god-send in terms of helping couples with sperm issues. It was certainly a clever idea.

There is no natural selection in terms of which eggs is fertilised by which sperm (remember in natural selection the bulk of the sperm is killed prior reaching the uterus anyway whether they are good ones or bad) and not every egg gets fertilised

Natural select certainly has a component of luck in it in terms of the individual, and yes the bulk of the sperm (both good and bad) are killed before reaching the egg. But only sperm with good mobility generally ever reach the sperm ... thus a screening process ... the next screening process is "can the sperm enter the egg" ... and then can the sperm fertilise the egg ... and finally can the combination of chromosomes grow from an embryo to a child. Thus natural selection is more apparent when you consider the sperm population (???) as a whole rather than an individual sperm. The better quality sperm are more likely to result in a child.

at this point I don't care if it is not natural selection.. I just want a baby..

Every couple who is LTTTC would totally agree. That is the great thing about ICSI as it bypasses getting to the egg and entering the egg, but then nature takes over again for the rest of the steps ... thus why ICSI is not 100% successful.

what is more morally troubling for me is the frosties I still have... I don't think I have the heart to destroy them....

As a donor I do not have a say in that. I would rather the embryos were donated to another couple who needed them but it is totally up to the recipient families.

Would you consider donating your embryos to other couples?

To answer your question about seeing "quality" under the microscope.. well when it comes to sperm, bad ones could certainly be seen because they are "deformed" in some way. That's is how they find out how infertile a man is.

You are only considering outside appearance. The "inside" counts too!!! It is possible that a sperm can look good on the outside and swim well but can not fertilise an egg ... thus why ICSI is not 100% successful ... it is not even close to 100%. We still have much to learn about human Reproduction.

[Kahlan]

Natural select certainly has a component of luck in it in terms of the individual, and yes the bulk of the sperm (both good and bad) are killed before reaching the egg. But only sperm with good mobility generally ever reach the sperm ... thus a screening process ... the next screening process is "can the sperm enter the egg" ... and then can the sperm fertilise the egg ... and finally can the combination of chromosomes grow from an embryo to a child. Thus natural selection is more apparent when you consider the sperm population (???) as a whole rather than an individual sperm. The better quality sperm are more likely to result in a child.

You are only considering outside appearance. The "inside" counts too!!! It is possible that a sperm can look good on the outside and swim well but can not fertilise an egg ... thus why ICSI is not 100% successful ... it is not even close to 100%. We still have much to learn about human Reproduction.

that is the reason why to me whether it is ICSI, IVF of IUI, it is not natural selection because the sperms that would otherwise be killed are still used, those that had to take the "perilous journey" to test out their "fitness" didn't. Thus I don't think IVF allow "more natural selection" to take place than any of the other methods.... It is just giving all the sperms an equal chance of fertilising the egg (which is very different to natural selection)...

While no miscroscope would give you a clear genetic screen to all sperms, the bulk of the "bad sperms" do get screened out by observing their physical characteristics. Even in natural conception aka natural selection, it is not foolproof against chromosome abnormality. that is the reason why 5 in 6 pregnancies (in natural conception) ends in early miscarrriage (and this has nothing to do with the mother's womb or what she did!)

Yes I have been thinking about donating our embies... though I think we have to serious discuss about it first. I have also thought about donating my eggs. But time is ticking for me and by the time we try for #2 and #3 I think I might pass the age cut off.

[SD2001]

SD2001 - there are no problems with DH's sperm or fertilization, thus we really don't need ICSI at this point.

Hi buliej,

You hit the nail on the head!!!

Your statement highlights the reason why I first started thinking about this ... given that my sperm is healthy, good quality and lots of them (has to be or else the clinic will not accept it) then why does the clinic use it for ICSI and not IVF? Is it just pure chance that the recipient families all needed ICSI or does the clinic just "go straight to ICSI"?

[buliej]

Hi buliej,

You hit the nail on the head!!!

Your statement highlights the reason why I first started thinking about this ... given that my sperm is healthy, good quality and lots of them (has to be or else the clinic will not accept it) then why does the clinic use it for ICSI and not IVF? Is it just pure chance that the recipient families all needed ICSI or does the clinic just "go straight to ICSI"?

I don't know the answer to that - I really thought ICSI was only for sperm/fertilization issues..

[Cuddlepie]

Very interesting thread. I was just thinking this very question myself this monring what to do for this cycle.

We have done two IVF cycles, we don't have fertilization problems however one thing I observed is there is a big drop off from D3 to D5 blasties. DH's sperm has good count good mobility, normal range of morphology but later on we found his SCSA dNA test was 30% which is high. This cycle he has improved his result to 10%, so FS still suggest to go with IVF, this is to assume that DNA result Was the cause of the result of the first 2 cycles's poor results.

But with seeing that people normally getting a lot more frosties out of number of eggs, I was tempered to use ICSI. FS suggested IVF his reason being, if there is no fertilization issues, there is no need to stress out the embyros to manually do this. One thing it is causing fragmentation of the embies, another is 'nautral screening' process that we are bypassing...

So now I am really torned whether to use IVF or ICSI...that is the question to answer.

But I was a bit surprised that clinic would go straight into ICSI without considering all factors, seems like doing a short-cut for me..

[SD2001]

I don't know the answer to that - I really thought ICSI was only for sperm/fertilization issues..

My thoughts exactly, buliej.