Comments on IVF Authority: ICSI: Should it be Restricted to Male Infertility ...

I do not have much faith in the hamster egg penetr...

2009-09-17T09:58:01.538-07:00

I do not have much faith in the hamster egg penetrationtest and do not order it at all.

Geoff Sher

Is the "hamster egg test" an accurate te...

2009-09-16T20:12:17.952-07:00

Is the "hamster egg test" an accurate test proving that ICSI should be done with IVF? My husband had one done, showing that his sperm only penetrated 30% of the hamster eggs. I have heard different opinions on this test, and if we should do ICSI with our IVF or not. What is your opinion?? I'm trying to figure if the micro-IVF would be worth it to us, as all of the other requirements are met for this procedure.

The best test is the Sperm Chromatin Structure ass...

2009-08-30T19:17:30.460-07:00

The best test is the Sperm Chromatin Structure assay (SCSA). Do not waste your time doing sperm chromosome tests.

Geoff sher

Really interesting stuff, thank you. You say that ...

2009-08-29T21:43:28.944-07:00

Really interesting stuff, thank you. You say that ICSI removes the vast majority of barriers to fertilization, except genetic reasons. Does that mean that a man can have a genetic problem that completely inhibits sperm's ability to fertilize eggs? Is there any way to test for this?

It is not possible to accurately evaluate egg qual...

2009-07-14T15:35:13.551-07:00

It is not possible to accurately evaluate egg quality and maturity unless you can see the 1st polar body (PB-1)immediately under the zona pellucida (the envelopment of the egg). Visualization of PB-1 requires that you strip away the cluster of cells (cumulus oophorus) that surrounds the egg. Having done so, successful fertilization of the egg mandates that ICSI be done.

Several studies have confirmed that there is no disadvantage in doing routine ICSI. While there can be no argument that ICSI is needed in male factor infertility, and in cases where the zona pellucida is thick and/or hardened (e,g. in women over 40 and in cases of PCOS). Since doing ICSI in other cases, would do no harm and by doing ICSI routinely we are better able to assess egg quality and maturity, I prefer to do ICSI as a matter of routine. However, in such cases,I do not charge extra for doing ICSI.

Geoff Sher

I'm interested in your response to the most re...

2009-07-14T14:20:54.378-07:00

I'm interested in your response to the most recent ART stats released by CDC (http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5805a1.htm). In that report, they state the following:
The use of ICSI in the absence of male factor infertility in women considered difficult to treat was evaluated separately. These groups included women who underwent previous ART cycles but had no previous pregnancies or births, women diagnosed with diminished ovarian reserve, and ones with fewer than five eggs retrieved. Within each of these groups, age-specific--live-birth rates for IVF-ET with and without ICSI were examined. In all but four cases, women who used IVF with ICSI had lower live-birth rates than women who used IVF without ICSI. The four exceptions were: 1) women aged <35 years who had previous ART cycles but no previous pregnancies or births; 2) women aged >42 years who had previous ART cycles but no previous pregnancies or births; 3) women aged 41--42 years with fewer than five eggs retrieved; and 4) women aged 41--42 years with diminished ovarian reserve. However, in all other cases, the pattern of these results is consistent with the findings presented in this report (Table 4). Additional analyses also fail to support a clear advantage in using ICSI when treating couples with no indication of male factor infertility. After adjusting for female prognosis factors and types of IVF procedures, cycles using ICSI with no indication of male-factor infertility were less likely to fail before transfer but more likely to result in implantation failure, pregnancy loss, and a lower overall chance of a live birth delivery. ICSI effects on the next cycle were slightly improved but not better than those without using ICSI.

ICSI is usualy charged for as an additional cost, ...

2009-07-08T07:48:55.362-07:00

ICSI is usualy charged for as an additional cost, but the amount varies from one center to another..ranging from about $1,000 to $2500.

Since we at SIRM advocate ICSI for ALL cases, we often do not charge for it unless it is being done for male factor, women over 40Y, women with Polycystic Ovarian Syndrome who tend to have eggs with hardened or thickened envelopments (Zona's).

Geoff Sher

Does the ICSI process increase the cost of IVF alo...

2009-07-07T18:40:33.765-07:00

Does the ICSI process increase the cost of IVF alot? My husband has only 3% normal morphology so we have been informed that this is our only hope.

Neither are true! Geoff Sher

2009-06-10T10:55:08.550-07:00

Neither are true!

Geoff Sher

Hi Dr. Sher, Is it true that ICSI is more likely...

2009-06-10T05:32:25.288-07:00

Hi Dr. Sher,

Is it true that ICSI is more likely to result in a boy vs girl, I read something about the male sperm swim more quickly or something like that...also, is it true that ICSI is more likely to lead to twins?

thank you

Thank you for your comment. I appreciate it! Ge...

2009-06-09T07:31:18.257-07:00

Thank you for your comment.

I appreciate it!

Geoff Sher

This was very interesting. When my husband and I ...

2009-06-04T05:17:01.227-07:00

This was very interesting. When my husband and I underwent IVF the first time, our clinic did half ICSI and half natural fertilization for the 18 harvested eggs. What do you know that they fertilized at the same rate! Exactly 7 ICSI and 7 natural.

Thanks for your blogs, they are so informative.