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]

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

[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