IUI vs IVF vs ICSI ???

[SD2001]

Hi all,

Why is it that IVF clinics (or my clinic anyway) only seem to utilise IUI or ICSI for fertilisation? Why don't clinics try using IVF before steering recipients straight onto ICSI? Just curious ... Does anyone have any comment regarding your clinic?

[briggsy's girl]

IUI and ICSI are very different - IUI isn't IVF related as such - it's insemination with a sperm sample direct to the uterus to meet with the egg that has been naturally (or medically) ovulated.

ICSI is more common because the chances of fertilisation are greatly improved. on our IVF cycle only 5 of 11 eggs fertilised - with ICSI, our results would have been much higher as the sperm is introduced to the egg so no "chance" result. it's all about getting the most viable embryo's each round. a lot of clinics now automatically use ICSI at no extra charge as the results are so much better.

HTH

BG

[SD2001]

Yes, I researched the different ART fertilisation methods and am aware of the differences between them.

My question is a more philosophical one.

It appears that my clinic basically goes directly from IUI to ICSI, with no apparent consideration of using (or advising the recipients of) IVF.

ICSI was originally a method of overcoming severe problems with male infertility (eg. Low sperm count, bad mobility, etc) though more recently it is also used to treat female infertility associated with "hard egg shells" (zona pellucida) as in the case of older ladies.

So why does it seem that clinics now use ICSI as the "standard procedure"?

One suggestion, as you also mentioned, is that clinics may use ICSI as a way to increase their success rates. Certainly IVF and ICSI have higher success rates than IUI, though IVF and ICSI success rates may not be that different (more on this in the next message).So, if the female recipient has no fertility problems and utilises donor sperm, then why does the clinic suggest ICSI and not IVF?

My next question is an ethical one (to provoke discussion). In the case of IUI or IVF, natural selection comes into play with (usually) the "best and fittest" sperm that fertilises the egg. However, with ICSI it is the case that the "luckiest" sperm is chosen by the lab technician to be injected into the egg for fertilisation. So with ICSI it is quite literally the lab technician who is selecting (albeit blindly) the outcome. So if the female recipient has no fertility problems and utilises donor sperm, then would it be better to utilise natural selection via IUI or IVF rather than ICSI, or is it acceptable for the outcome to be selected by a lab technician?

Lastly, do recipient couples who utilise ICSI ever research if the ICSI process affects the resulting offspring?

There are no right or wrong answers, just individual points of view. What is yours?

[SD2001]

Hi BG,

ICSI is more common because the chances of fertilisation are greatly improved.
BG

Have a quick look at this link:

100 Questions and Answers about ... - Google Book Search

it's all about getting the most viable embryo's each round. a lot of clinics now automatically use ICSI at no extra charge as the results are so much better.
BG

But is it the case that "nature" is selecting the most viable embryos using IVF as apposed to ICSI where the lab technician is randomly selecting and matching a sperm to the egg?

Regards

[butterfly_warrior]

For us, the only option was ICSI due to severe male factor infertility on top of my severe PCOS. However, my FS said that in the absence of male factor problems, he'd still use ICSI as it gives much better results for women with PCOS. I wish I'd thought to question why...

I really don't believe it's bypassing natural selection, as the embryologists will be searching for the best-looking, best-moving sperm in the sample. They aren't just going to catch any old sperm, they will be looking for quality.

Also - ICSI doesn't guarantee fertilisation. I've had eggs injected that failed to actually fertilise. Don't know whether that's a sperm problem or an egg problem as it happened on cycles where I was hyperstimulated and egg quality was pretty poor. It also happened on the non-hyperstimulated cycle, which is why we went from 12 mature eggs to only 3 that fertilised, even using ICSI.

BW

[buliej]

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.

However, your queries raise a general question I have - how much do you question/challenge your FS?

Do most people just trust that their FS is doing absolutely everything they can?

I'm thinking of asking my FS what she would recommend if she wasn't constrained by law or or clinic rules - meaning are there things I'm missing out on trying because they are not yet approved here in Aus although they have been shown to have a positive impact on outcome elsewhere and/or the particular clinic doesn't believe in them (such as a particular drug or going to 3 day or blast transfers). I really want to know whether we are doing everything we can - or whether there are other options out there in this world that we should be considering.

[SD2001]

Hi BW,

I really don't believe it's bypassing natural selection, as the embryologists will be searching for the best-looking, best-moving sperm in the sample. They aren't just going to catch any old sperm, they will be looking for quality.

Yes, that is true. But I assume there is more to quality then can be visually seen through a microscope.

Also - ICSI doesn't guarantee fertilisation. I've had eggs injected that failed to actually fertilise. Don't know whether that's a sperm problem or an egg problem as it happened on cycles where I was hyperstimulated and egg quality was pretty poor. It also happened on the non-hyperstimulated cycle, which is why we went from 12 mature eggs to only 3 that fertilised, even using ICSI.

Yes, it is hard to say which was the problem ... the eggs or the sperm. But it is possible that one reason that some eggs (that are implanted with a sperm via ICSI) fail to fertilise is due to the sperm selected by the technician. The mysterious unexplained fertility problems that some couples experience could be due to some level of quality in either eggs and/or sperm that we are yet to be able to detect. I guess it could also just be chemistry ... maybe some eggs and sperm just do not "combine" correctly. IUI or IVF may help avoid this in some cases???

SD

[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]

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"?

[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.

[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..

[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]

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

My thoughts exactly, buliej.