18 Responses to “ICSI: Should it be Restricted to Male Infertility or be a Routine Part of all IVF?”

1. osuraj says:

   June 4, 2009 at 5:17 am

   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.

   Reply
2. Geoffrey Sher, MD says:

   June 9, 2009 at 7:31 am

   Thank you for your comment.

   I appreciate it!

   Geoff Sher

   Reply
3. Anonymous says:

   June 10, 2009 at 5:32 am

   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

   Reply
4. Geoffrey Sher, MD says:

   June 10, 2009 at 10:55 am

   Neither are true!

   Geoff Sher

   Reply
5. Dead Hero says:

   July 7, 2009 at 6:40 pm

   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.

   Reply
6. Geoffrey Sher, MD says:

   July 8, 2009 at 7:48 am

   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

   Reply
7. Schuff says:

   July 14, 2009 at 2:20 pm

   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.

   Reply
8. Geoffrey Sher, MD says:

   July 14, 2009 at 3:35 pm

   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

   Reply
9. vanessa says:

   August 29, 2009 at 9:43 pm

   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?

   Reply
10. Geoffrey Sher, MD says:

    August 30, 2009 at 7:17 pm

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

    Geoff sher

    Reply
11. Bri says:

    September 16, 2009 at 8:12 pm

    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.

    Reply
12. Geoffrey Sher, MD says:

    September 17, 2009 at 9:58 am

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

    Geoff Sher

    Reply
13. Andrea says:

    August 20, 2012 at 11:40 am

    Is ICSI recommended for those with endo and NO MFI? We’ve never been pregnant and our dr has recommended ICSI with our first IVF.

    Reply
    • Geoffrey Sher says:

      August 20, 2012 at 12:14 pm

      Indeed it is. Might I recommend that you go to the home page on this (www.IVFauthority.com) site, where you will find a bog posted today (or to be posted tomorrow , on this very topic. Thereupon, you might consider calling 800-780-7437 or 702-699-7437 to set up a web-based video conference with me (which is free if you reside in the U.S.A or in Canada) to discuss your case in detail.

      Geoff Sher

      Reply
14. saanya21 says:

    February 5, 2013 at 10:04 pm

    Your article is very informative though i have some questions.we just did semen analysis as we are going for ivf/pgd for gender and results are as follows
    volume 1.5 ml
    count 76 million(motile 47 million and 11 were progressive motile)
    morphology 3% kruger

    what do you think ?does he need any medication or treatment to make it better.please advice as we are very worried thx a million

    Reply
    • Geoffrey Sher says:

      February 5, 2013 at 10:53 pm

      In spite of the slightly reduced morphology, I would hazard a bet that his sperm is OK. It might be helpful to get a sperm chromatin structure assay done and if the DNA fragmentation index is normal I would not be concerned. There is probably not much you can do to improve sperm function in the lab. If it is to be improved, it needs to be in the body. There are many male fertility blends available. I usually recommend “Proceptin”. It cannot be bought at a drug store. Those interested should go to http://www.Proceptin.com to get some and to learn more about this blend of antioxidants that might enhance sperm fertilization potential.

      Use of hormonal therapy to enhance spew rm is largely confined to cases where production is down because of under-stimulation by the pituitary. In many cases clomiphene taken at 25mg a day for 3 months (the length of the sperm cycle) will help. It wont ‘t benefit cases where there is already high normal or elevated blood levels of FSH. In such cases nothing will really improve matters. Only IVF/ICSI might overcome the problem. Injectable gonadotropins may help when there is a severe underproduction of pituitary FSH and hCG sometimes improved sperm motility.

      Go elsewhere on this blog and find an article I wrote on Medical enhancement of sperm production.

      Good luck!

      Geoff Sher

      Reply
15. saanya21 says:

    February 6, 2013 at 10:43 am

    sorry i forgot to write . its 11 million that were progressively motile.from the count 76 million(motile 47 million)
    volume 1.5 ml
    morphology 3% kruger

    my questions are
    1.is the motility is on low too or just the morphology?
    2.the test SCSA that you are saying where can it be done ?
    3.and if the results come high what can we do?we were doing ivf in june do you recommend should we wait and do the proxeed/procetin or go ahead .
    thx lot.

    Reply
    • Geoffrey Sher says:

      February 6, 2013 at 11:01 am

      The motility seems OK. Ask your RE about the SCSA! If the result is high then treatment depends on the cause. Again, your RE should discuss with you.

      Geoff Sher

      Reply