to ICSI or not to ICSI?




"Dr. **** here.  Got a minute?  Let's chat.  I reviewed your history with the team and the consensus is you two should undergo ICSI.  You don't have to make the decision it over with [him] and you can change your mind as late as the morning of your embryo transfer".


So a few weeks ago, we were in a mandated IVF educational session with four other couples.  This 5+ hour catered session was facilitated by the Chair of the department and a very well respected, accomplished, and published OBGYN.  This particular fertility institute prides themselves in the partnership between patient and doctor -- at each juncture in the process, a discussion between all parties is held and a decision is reached no matter how difficult.  At no point does the medical team impose or force their recommendations on a patient unless the alternative is deemed medically unethical.  [This was not the case in our dealings with the previous fertility clinic]  In the session, we learned everything one needs to know about IVF -- and since we're in a research hospital, we also learned their particular techniques and madness behind their unique methods.


Where as IVF generally involves exposing harvested eggs to motile sperm in a dish hoping for fertilization, ICSI takes it a step further.  An embryologist selects a single sperm from the sample, clips off the sperm's tail and injects it directly into the egg, then monitors the progress hoping for fertilization within 2-3 days.  If it takes, they let the egg mature (another 5 days) then transfer the blastocyst into the woman and hope it implants -- if so, you're pregnant!  This process is usually recommended for a number of my case, because I have unexplained (or undiscovered) fertility.  If you recall, I had chemo at 25 years of age without having harvested my eggs  --- could they have been fried? (pun totally intended....lighten up people!!!!)  The quality of my eggs is unknown at this time...


ICSI sounds like a no-brainer!  Why come this far and not afford yourselves the best chances for success?


This juncture....this a huge point of contention in the field, the doctor added.  There's great debate on whether this process leads to higher rates of birth defects.  He added that normal IVF pregnancy birth defect rate is 1-2%, but with ICSI it's 2-4%.   Are one's chances indeed doubled? Or is the sample of IVF patients so small and that of ICSI even smaller for this statistic to be noise-worthy?


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