To ICSI or not to ICSI

Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat sperm-related infertility problems. ICSI is used to enhance the fertilization phase of in vitro fertilization (IVF) by injecting a single sperm into a mature egg.
Under high-power magnification, a glass tool (holding pipet) is used to hold an egg in place. A microscopic glass tube containing sperm (injection pipet) is used to penetrate and deposit one sperm into the egg. After culturing in the laboratory overnight, eggs are checked for evidence of fertilization. After incubation, the eggs that have been successfully fertilized (zygotes) or have had 3 to 5 days to further develop (zygotes or blastocysts) are selected. Two to four are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. The remaining embryos may be frozen (cryopreserved) for future attempts.

Intracytoplasmic sperm injection (ICSI) is used to treat severe male infertility, as when little or no sperm are ejaculated in the semen. Immature sperm collected from the testicles are usually unable to move about and are more likely to fertilize an egg through ICSI. It is also helpful when the sperm is poorly shaped, it allows the embroyologist to pick the best sperm to fertilize the egg with.

Some couples choose to try ICSI after repeat in vitro fertilization has been unsuccessful. In the United States, about half of IVF procedures are currently performed using ICSI technology. Myself I find this absolutely crazy, why would couples not want to ICSI, why would you want to take the risk of eggs not fertalizing? I just do not get that!!

ICSI is also used for couples who are planning to have genetic testing of the embryo to check for certain genetic disorders. ICSI uses only one sperm for each egg, so there is no chance the genetic test can be contaminated by other sperm.

There has been some studies that show that using ICSI gives you a slightly higher change of having identical twins, but there is not enough evidence to support that quite yet.

So, we will be doing ICSI, we have to, with John's sperm which is poorly shaped and the potential that my eggs are too hard, that would make natural fertilization more difficult. So whatever the risks, I feel the benefits outweigh the risks.

Drama on the internet!

Let me start by saying that I am addicted to Thenestbaby.com, its a great resource for me, there are mesasge boards for all different types of fertility issues. I tend to hang out on the Trouble Trying to Concieve board and the Success after Infertility board. Well, today some shit went down. There is a girl on the Success after Infertility board who had her first daughter last March after no fertility treamtents, it was a "miracle" cycle that she happened to concieve. Well, her daugher just turned one and she just went through a miscarriage, she concieved very easily again, but lost it early on. Well, first month after the miscarriage she and her husband "accidently" had sex and she got pregnant again. Well, she comes over to our Trouble trying to concieve board and gets up on her soap box about how poor sperm morphology is no big deal, because she has gotten pregnant a bunch of times, and has a beautiful daughter to show for it, and how we should all have hope because she can get pregnant and her husband had one seman anaylsis that showed poor morphology.

Well, did girls get upset, she is certainly the most fertile infertile that we have all met! Yes, I am happy that she can get prengnat so easliy, but do not come over to our board and talk about how easily you can get pregnant when there are tons of women get get pregnant with poor morphology through IVF and ICSI. I truly wonder if this freak show's husband even has sperm issues, he had one damn test that showed it, and that means NOTHING. Try having several seaman anaysis's that show poor sperm quality. So don't parade around telling us it can happen to you, and it will happen to us! I could have sex all day long, we need medical intervention, not a freaking story about how one girl got pregnant. Yes, there is also a chance that I would win the lottery, does that mean I sit around and wait, HELL NO! Why would I sit around and wait for a stork when I could do IVF and fix our problem?!

I hate these women who give false hope to other women, there is a fine line between hope and advice. Hope for me comes from the dozens of women who have been successful with IVF on their first try. Not that fluke pregnany that comes out of no where.

I love my nestie girls! I never thought I could be so close to women that I have never met.

IUI's a new interesting study!

I found this article interesting because having been told that IVF with ICSI is out best option due to having boardeline sperm morohology issues. The age old question is where is the cut off line between doing IUI and doing IVF, most fertility specalists will say to do at least 3 IUI's before moving to IVF, while others say with certain criteria do not even try and IUI, do not pass go, do not collect $200, GO STRAIGHT TO IVF. This article takes men with a strict morphology of 5% and below and 5% and above and tests the pregnancy rate of both groups.

Normally multiplying the total motile sperm count by the percent of normal sperm determined by strict morphology (TM×SM) may be a significant predictor of pregnancy when sperm morphology is less than 5%, according to a new study by Texas researchers. It as been said that with a less then 5% morphology there is a harder time achieveing pregnancy.

It has been suggested that in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) may be the best treatment option for couples with less than 5% normal sperm strict morphology. Wanting to investigate whether the 5% threshold or the TM×SM was a significant predictor of intrauterine insemination (IUI) success, researchers looked at infertile couples undergoing IUI at their institution between November 1995 and December 2007. Their findings suggest that TM×SM may be helpful in selecting couples who are not suitable for IUI.

Females that were excluded from the study had an age greater than 40 years, history of endometriosis, tubal factor, or history of previous IVF or use of donor sperm. A total of 237 couples were included in the study. The investigators determined total motile sperm counts for each of the initial semen analyses and used the Kruger strict morphology criteria to calculate the percentage of total normal sperm, then multiplied to get the TM×SM.

The overall cumulative pregnancy rate was about 30%. Mean female age, mean strict morphology, mean TMC, and mean TM×SM in both the pregnant and nonpregnant groups were similar. The pregnancy rate was 24% in couples with strict morphology less than 5% (about 45% of the cohort) compared with a pregnancy rate of 34% in couples with strict morphology of 5% or more. The difference was not statistically significant.

In couples with SM less than 5%, the pregnant group had a significantly higher mean TM×SM compared with the nonpregnant group (3.7 million vs. 2.3 million). No pregnancies occurred in the 14 couples whose TM×SM was less than 0.29 million. Overall, TM×SM was the only significant predictor of pregnancy in couples with SM below 5%.

In laymans terms this study tells us not to look at strict morphology alone. You should also look at the total motile count and combine it with the strict morphology, said study investigator Ertug Kovanci, MD, assistant professor of obstetrics and gynecology at Baylor College of Medicine in Houston. “Sometimes IVF with ICSI is recommended just because the strict morphology is less than 5%. But we are saying that if the total motile count is good, you don't have to do IVF with ICSI [in these couples]. You can get away with IUIs.”

That is great news, because it could potentially lead to huge costs savings because IUI is both less invasive and less expensive. Obviously if continued IUI's are not successful then it is important to speak to your fertility specalist about moving forward to IVF with ICSI, but this study gives hope to those who have boarderline sperm morphology numbers. In our case, we were told go right to IVF with ICSI, but after some time and lots of vitamins John's sperm had improved and we now fit into the parameters to do IUI's and John has put up steller numbers at both of our IUI's. So things change, espiclly sperm. One thing to keep in mind with IUI's is the success rate is not as high as an IVF on one cycle, so it may take more then one cycle to achieve pregnancy, do not give up hope.
Best of luck to you!

Its all about the Sperm!

Our official diagnosis is male infertility, due to low morphology. Now if you didn't understand a word in that sentence I will explain.

Men have a biological clock, just like women, only their ticks a little slower, but can still create problems. The easiest thing to check and normally one of the first things to do when dealing with the inability to get pregnant is to have a semen analysis done on the male. All of the women's test are very invasive and can be painful, where a semen analysis is very easy for the male to do and is not invasive at all.

There are 4 things that are tested in a semen analysis:
Volume- Should be at least 2 ml
Sperm Count- Should be at least 20 million per ml
Motility- Should be greater then 50%
Morphology- Should be greater the 14%, but anything over 4% is considered decent (Kruger scale) if testing on a WHO scale it should be greater then 30%

There are 2 scales with morphology, Kruger is stricter and is used by fertility specialist, WHO is used by most basic labs. I really suggest the Kruger scale, because it will give you a better test, but it just depends on your lab and what type of doctor ordered the test.

There is a lot of debate about morphology, as to how much effect it has on male fertility, and its a heavily debated issue in the world of fertility.

My husband has been diagnosed with having low morphology, so we are told that his sperm cannot penetrate my egg and fertilize it. Well, that does create a problem, if the egg cannot be fertilized then I cannot get pregnant. It all makes sense. But the good thing is that he has sperm and they are good swimmers.

We were told that IVF with ICSI ( intracytoplasmic sperm injection) was our best option, because it allows the lab to take the sperm and directly inject into my egg, therefore taking our sperm problem out of the equation. The fertilized egg will then be put into my uterus and hopefully implant, and then I am pregnant! We were told if we going to have a problem, this was a good problem to have, because it can be solved very easily. IVF with ICSI is very common, it gives the best results.

So if you having problems getting pregnant have your husband or partner get a semen analysis, it may give you insight as to what the problem is.