Only 1 egg - ICSI or IVF?

[Nickyj76]

Hi,

This is the first time I've posted on here, but have been following quite a few threads previously. I've just turned 44 and I'm in the middle of my 7th round of IVF (in the space of 17 months), doing it solo. I haven't responded well at all this cycle and it looks like I'll be going into egg collection for just one follicle - no point cancelling and seeing if next month is any different at this age now.

My last cycle last month was the first time I opted to use ICSI and AOA as I don't want to look back and have the 'what if' questions and need to feel like I've tried everything - the 5 cycles prior to that were all full IVF fresh transfer cycles, all negative pregnancy tests. Last cycle my plan was to freeze any good quality day 3 embryos so that I could take a few months out to get some breathing space and then be able to, hopefully, try a few frozen transfers (again so that I know I've tried everything before I have to walk away as the previous 5 fresh transfers didn't work). Last cycle was a disaster as we collected 2 eggs (I've typically been getting 4 for the cycles prior to that) and only 1 fertilised normally (the other fertilised abnormally) and come day 3 the quality had dropped to 'average/fair' rather than the 'good' quality I'd been getting in the previous cycles. So last cycle was the first time I had nothing to show for it as it wasn't good enough quality to freeze and I opted to not transfer.

My question is, if you had only 1 egg would you use ICSI/AOA again or opt for IVF instead? My 3rd cycle ended up with only 1 follicle responding and we got 1 egg, but that time I used IVF not ICSI and it fertilised. My concern about using ICSI with just 1 egg is that there are clearly more risks compared to IVF as piercing the egg can damage around 5-10% of good quality eggs, plus the other risks associated with it. However, if I use IVF it may not fertilise at all. This could be my last ever egg as not sure I can go through a further 8th round and if I do it would, again, be in the hope I can get a couple more in the freezer for later use.

[Gueritarubia]

Hey, wow, what a rollercoaster for you! If you’ve previously had success with IVF and there are no sperm issues, I’d go IVF. With ICSI, the embryologist has to select a good-looking sperm to inject. They might not select the very best as not all parameters can be judged? If egg and lots of sperm are together in a Petri dish, the best sperm will win - survival of the fittest, natural selection if you will. My first cycle they did half-half to see what worked better and we had a better fertilisation rate with IVF than ICSI.

Good luck whatever you decide!

[Florencehill]

Hi Nickyj76,

Sorry to hear about your dilema and yoir long journey. Decisions like yours can be very hard to make, especially if you have nobody around you who has gone through IVF and understands the heartache and the weight of every step.

I think ultimately this has to be your decision alone, but here is my opinion.

I would opt for ICSI. Im 42 and my consultant in my most recent round of IVF persuaded me in an instant to tick the ICSI box rather than natural IVF fertilisation I had ready ticked. I asked him about the risks and he said there were none. (obviously there is a very small risk, but not enough to change his mind) On the previous NHS cycle my partners sperm fertilised 100% of my eggs without ICSI, which is why we had faith. But Im glad we went with ICSI. All of our 16 eggs were fertilised, and I later realised that his sperm sample this cycle had gone from absoutely normal a couple of years ago to lower than is acceptable (teratozoospermia). I dont know the quality of the sperm you are using but its definitely a factor. The remedy for low grade sperm is ICSI (and changes in lifestyle)

From where I am standing, ICSI is the best choice. They will select a good little swimmer that looks good to fertilize your egg.

I hope that helps and wishing you all the best that this egg is the golden one.

[Rumi40]

Hi Nicky, wow your story just puts life into perspective. i had recently added a post here too called 'poor responder - cancelled cycle' and wanted advice as i basically got 4 follicles from a mild stimulation but only one reach 9mm day 13 and the doc cancelled my cycle. i am waiting for my follow up. if you have only one egg and are on round 7, i would throw everything at it and also I'm a firm believer in meditation and mindfulness towards the body. name your egg, speak nicely to your body and be gentle on yourself. i don't know what is next for me but 7 rounds of IVF already i take my hat off to you not to mention the cost. good luck my love.

[Ivfgotadream]

ICSI supposedly has much higher fertilisation rates (for me my egg quality was poor though and until I changed to natural modified IVF struggled to get more than 30% fertilised)

I would also say that at age 36-37 I did 5 rounds of IVF in 18 months and found by the last one it was clear my body had just had enough and didn’t respond the same way anymore to the medications (even with a 3 month break between egg collections due to covid) and it was a struggle to get just one follicle compared to the 14 I was getting the previous year