Should I go for ICSI to increase chances of IVF success?

Each year, millions of couples around the world receive the tragic news that they are infertile. Gone are the times when infertility was always considered a female issue. Now, a little less than half of the infertility cases around the world can be attributed to male infertility. Male infertility was always an issue. However, its incidence has increased considerably over the last few decades due to unhealthy lifestyle changes.

Additionally, with the advances in medical technology, it is now possible to diagnose male infertility successfully, which was only a distant possibility a few years back. Be it male infertility or female, both these conditions can cause immense emotional distress among the couple in question. Managing infertility is a tedious task to do for such couples.

A majority of them opt for non-surgical interventions such as lifestyle adjustment, exercising, and medical management to overcome infertility. Partners who are not able to conceive naturally, even after years of attempts, often resort to artificial reproductive techniques (ARTs) for help. In vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are the two most common ARTs that are in use today.

However, a majority of infertile couples often find it confusing to differentiate between the two. Additionally, they are often unsure when to opt for IVF or ICSI and what benefits each offers. This article explores when a couple should opt for IVF or IVF with ICSI. Additionally, it details whether ICSI is a successful tool for IVF.

The Basic Difference Between IVF and ICSI

The basic difference between IVF and ICSI lies in the environment in which the procedures are performed. In the case of IVF, the eggs and sperm are fertilized in a Petri dish. However, in ICSI, the embryologist uses a micromanipulator to give the sperm a boost so they can enter the egg. The ICSI allows the selection of a good sperm for direct injection into the egg. This, therefore, increases the chances of successful fertilisation. While specialists advise using IVF in the case of female and male infertility or both, they advise ICSI especially for the following cases:

Low sperm count
Low sperm motility
Structural defects in the sperms
Failure of previous IVF attempts
Poor fertilisation rate
In the case of embryo testing
Use of frozen sperms

Should I Choose ICSI for IVF Treatment?

The success rates of IVF and ICSI are equally good. However, some infertility experts prefer doing IVF with ICSI rather than just simple IVF. This is because of specific reasons apart from the most obvious cause of female infertility. During ICSI, the oocytes are denuded before the procedure. Therefore, the infertility specialist can actually examine and assess the quality of the oocytes at this stage. This is quite important to do in case of women who are above 35 years of age and other women who have a poor ovarian reserve. Thus, ICSI can act as a checkpoint and provide the couple with the exact success rates if oocyte quality is poor. Accordingly, the couple can arrange for an egg donor is the oocyte from the female partner cannot be used properly.

This helps avoid unnecessary expenses associated with repeated IVF cycles due to poor egg quality. There is one more reason why it could be wiser to go for ICSI even when the male counterpart has a normal sperm count. Some of these males may still have total fertilisation failure. This is an unexpected blow that could completely devastate the couple, emotionally and financially, if it happens.

There is no way to identify total sperm failure before IVF, and if it happens, all the efforts, time, and money that go into the expensive IVF cycles go to waste. In case of total fertilisation failure, the couple has to start another IVF cycle with ICSI. By opting for ICSI at the first instance, such cases can be automatically prevented. However, that does not mean that IVF is unsuccessful for most couples. In fact, most of them conceive within two to three IVF cycles.

Some Myths About Icsi That People Must Stay Away From

Harms the Egg: Many people believe that, since a sperm cell mechanically enters the egg during ICSI, this may harm the egg. However, that is not true. The damage to the egg is less than 2 per cent if the procedure, which an experienced embryologist carries out, is ICSI.
May Result in Abnormal Embryo: It is a common belief that the healthiest sperm fertilises the egg in IVF. However, if the embryologist selects an abnormal sperm during ICSI, then the resulting embryo will also be abnormal. However, this is not true. In ICSI, the embryologist, in fact, has a chance to select the healthiest sperm for fusion. There are millions of couples who have conceived healthy and completely normal babies so far using this technique.
May Cause Genetic Deformity: There is no reason to worry that ICSI may cause a genetic defect in the resulting baby. If the sperm of the male partner has a Y chromosomal microdeletion, then the male baby will also have Y chromosomes with the same microdeletion. However, if the sperm is healthy, then there are no chances for a sex chromosomal defect or any other genetic malformation to appear in the baby. However, it is always better to discuss the case with an experienced IVF specialist before choosing to favour any technique. An infertility expert analyses the case and selects the most appropriate treatment approach based on the individual's health profile and needs.

In a field where patients are desperate for good outcomes, many doctors think it is a mistake not to employ every weapon in their arsenal. Especially when they believe the costs and risks of using treatments like ICSI are relatively harmless. Of course, most doctors acknowledge that their perception of cost may not align with that of their patients, and many patients, when making such an emotionally charged decision, struggle to calibrate risk rationally.

As for the medical risks, most studies indicate that the absolute impact of employing ICSI is small, but because ICSI is a delicate procedure that bypasses natural selection, it carries more risk than utilising natural insemination.