IVF vs ICSI for borderline MFI

[Nightingale92]

Hi everyone,

I was just wondering if anyone had any thoughts on standard IVF vs ICSI if you have MFI but it’s not too bad?

We conceived naturally 3 times…one early loss, one living daughter (4yo) and then a daughter we lost to PPROM/premature labour (2 years ago). After losing our daughter we TTC for 18 months with no luck. We did some fertility testing and OH’s first semen analysis came back “borderline” and the second one “suboptimal”. None of the measures were horrendous, but they decided that’s where the issue was. He’s only just turned 30 and fairly active and healthy, so it was a bit of a shock.

We were self-funding and they suggested ICSI for best success rates so we just dove into it. We only got 2 mature eggs, but both fertilised and made good quality embryos (5AA and 5AB). They actually injected the other 3 (immature) eggs and all of them fertilised too (but none made it to blasto). They said the sample OH provided was good, and they managed to get enough for 5 rounds from him - so much better than expected!

Our first (fresh) transfer was BFP but ended on loss at 7 weeks. Our FET was BFP but baby was growing slowly and heartbeat stopped at 10 weeks 😔

I’m wondering if we would be better doing IVF than ICSI next time? I know ICSI has slightly higher miscarriage rates and wonder whether them forcing fertilisation just made embryos that weren’t genetically sound…? I know we risk lower success with fertilisation going through standard IVF, but I’m not sure I can face another loss through an embryo that isn’t quite right 😔

Has anyone had this dilemma/issue? What did you decide?

Thanks so much in advance! ❤️

[Skittles11]

Hi Nightingale. My husband also appears to have sub-optimal / borderline sperm according to our clinic notes although nobody ever spoke to us about it, I just saw it written down!

When we first started fertility treatment we were doing IVF at our original clinic. After experiencing a trauma (unrelated to our clinic) we moved clinics and were advised to do ICSI. We had experienced rounds where fertilisation was good and then rounds where it was not so good so I think this all informed the recommendation.

Have you considered genetic testing? That would probably be one thing you could look at to help gather information about how genetically sound the embryos are. I know it's not for everyone though xx

[soccerkt6]

Hi lovely

I'm so sorry to hear about your losses.

Considering your history, I agree with Skittles that genetic testing should probably be your next step before you do another cycle. Both you and your husband should have a karyotyping test done to make sure that neither of you have any genetic issues that are causing problems. Since you've had more than 3 miscarriages, you should be able to get this done through your GP and you can also request a "recurrent miscarriage" blood panel to be done alongside the karyotyping.

Your husband should probably also have a sperm DNA fragmentation test done. If the DNA in his sperm has a lot of breakages, it's been known to cause miscarriages and difficulty conceiving. Standard semen analyses can't test for DNA frag (though suboptimal semen analyses can sometimes be an indicator that there's a deeper issue), so it's a specialty test that he'll need to have done through your IVF clinic.

If all of the above come back normal, you may want to consider PGT testing of any future embryos before you transfer. The record on PGT is a bit mixed, but it can give you peace of mind knowing that you're only transferring chromosomally normal embryos.

Best of luck xxx

PS - To answer your original question, I don't think going back to conventional IVF will make much of a difference. While the miscarriage rate with ICSI is marginally higher, I think it will be much more effective to try to figure out what's causing the genetic abnormalities in the first place and correct it (if you can).💛

[Twiglet2]

agree with the ladies I think your clinic will likely recommend testing the embryos after so many losses your fertilisation and implantation rates are really good so I would personally be focusing on that stage rather than the actual ICSI process or protocol etc. I’m so sorry you have such a rough ride with so many heartbreaks 💜 I think testing would help you avoid those (and that’s coming from someone who has chosen not to test this round) good luck to you both xxx

[DianeArnold Partner Nurse Fertility Network UK]

Hi Nightingale. Can I add my thoughts re genetic testing? Just might be the way to go now, so you know your created embryos are good. Hope all goes well next time. Diane

[Missl73]

I think that the higher rate of miscarriage with ICSI is most likely because it’s used in cases of more severe male infertility which means the sperm likely has higher DNA fragmentation which is associated with miscarriage. I agree with the other posters that more testing is the way to go at this stage and would be a better use of your money. It really hope you find a path forward, it’s been a tough journey you’ve been on xx

[Rain415]

Hi, my husband had borderline low count and low morphology. We were going to do icsi but got 12 eggs so they decided to do half of the eggs icsi and half ivf. We had 3 blasts from icsi and 1 from ivf. So we did get more from icsi and one is our son (we have the ivf one in the freezer) the fertilisation was higher with icsi but I'm very happy that we got one with ivf as means the sperm can bind to the egg. Just to give some stats on what happened with us. Wishing you all the best! X