IVF/ICSI due to Male Factor - A Question

[abennion]

Hi all,

We are currently waiting for our first appointment with the Regional Fertility Program here in Calgary. DH was diagnosed with 2% normal morphology back in December. Just got the call last week! Our first appointment is May 3.

My MIL brought up a thought that I thought I would ask here... since we can't really afford to do more than one cycle, we are planning on them placing 2 embryos this round.

This being the case, how likely is it that we would conceive twins knowing we will probably be doing ICSI due to male factor? Anyone have an experience similar?

 

[messica]

As long as ICSI is done and the embryos are developing normally, the ability for both to stick largely comes down to you. I had two children from a previous marriage and was considered a "fertile myrtle" by most standards. MFI was the issue with conceiving with my husband and we opted to transfer the only two good looking embryos from our one and only shot at IVF. They recently turned 16 months old

I wish you the best of luck!

 

[abennion]

Thank you messica! We're very excited at the thought of possibly having twins.

 

[BronteForever]

Do you know if you have to even do IVF yet? Morphology is fairly subjective which is why my clinic likes to see it above only 4 percent to consider it within "normal" range. As long as your husband's motility and amounts are in a good range, I don't think the morphology necessarily indicates IVF. You might have other, cheaper assisted conception options open to you, so I'd be surprised if they didn't mention that.

We have to do IVF because of my issues but my husbands counts are good and even though his morphology is approximately 3 percent, the doctor says we likely won't need ICSI during our IVF.

I'm kind of surprised hearing this if they told you IVF with ICSI is required in your call. Hmmm...weird.

And the doctor will recommend the number of embryos to transfer, usually it's 1-3, depending on the guidelines of your clinic and what your doctor recommends for your case. But yes multiples are a very real possibility with most assisted conception.

Good luck!

 

[abennion]

HI Bronte,

Our family doctor has advised us we will most likely have to do IVF. We have tried several cycles of Clomid with no success (our family doctor can prescribe), and have met with other couples who have gone to the same clinic we are going to with the same issues (male factor low morphology only) and after completing their preliminary testing were sent straight to IVF/ICSI.

It may just be how the Calgary clinic approaches morphology. There are articles online (just found through my own research) that suggest the only way to really handle morphology is through ICSI, as part of the issue is that the sperm are not meeting with the eggs properly.

Thank you for the information though. We are trying to gather as much as we can that way we can bring forth some good questions to our first appointment.

 

[BronteForever]

Got it, I didn't realize you'd tried Clomid already. I know IVF with ICSI is your best shot for sure, no matter what. It's just a matter if you wanted to try lower-priced options first, which possibly might take longer. I know alot of people on here who have gotten pregnant with low morphology, it just might have taken longer than average.

Whatever you decide, good luck to you, and I hope your first appointment goes well.

 

[BronteForever]

Just checking in to see how you are doing and to possibly give you some hope of how little morphology really affects the ability for fertilization since it's so subjective. Anyway we just finished our first IVF round and even though my husband's morphology was only 3 percent the doctors said we didn't need ICSI, since his count and motility were all good. So we decided to save the money. Out of 11 mature eggs, 9 fertilized naturally without ICSI (which is above the 60 percent normal fertilization rate during IVF). EDITED: So a low morphology might not impact your odds of success at all of fertilization itself. It really depends on lots of other factors.

How did your appointment go?

 

[messica]

Low morph is often times the only factor holding a couple back from conceiving. To say it shouldn't impact odds at all isn't accurate by any stretch of the imagination. The TYPE of issue regarding low morph is what matters. Short or longerish "tails" don't present near the same obsticle as rounded heads that are unable to penetrate. Sure if morph issues are related to tail yours odds of success in time are higher, but if most have double heads or heads too round to penetrate, no amount of time will fix that and yes, ICSI will make all the difference.

 

[BronteForever]

Not sure if you are talking to me or not Messica - but I agree it can impact fertility; I just said that I don't think morphology alone is going to make an RE clinic go straight to IVF without trying other options first (but of course that depends on what the patient wants to do). But good points about clarifying the different types of morphology, which is important.

I think the point I was saying was that it's an incredibly subjective field by itself and three different embryologists could look at a semen result and give you 3 different morphology reports, since the look of the semen is very subjective depending on who examines it. Sure they have guidelines, but it can vary and definitely doesn't mean IVF is the only option. That's been my experience in U.S. clinics, but it sounds like it's done very different in Canada.

And I was only giving an example in my case of what a 3 percent general morphology report resulted in in terms of fertilization, since I thought it would be helpful to know as an example that in my case 9 out of 11 eggs were still fertilized "naturally" even without doing ICSI and a morphology of 3 percent. But yes, I know that varies greatly from person to person for any number of reasons. I was in no way implying anything in anyone else's case at all, sorry if it sounded that way.

I can see now in my last comment I should have phrased it as saying "low morphology might not impact your ability for it to fertilize" since that's what I meant. I can go back and change it if that helps.

And my goodness, if you are going to pay for IVF because it does of course have the best success rate and there's any question at all by all means pay the little bit more for ICSI to be sure! We had our embryologist give us a report on my husband's semen the day of procedure to do a double check to make sure we didn't need to do a last minute change to ICSI and I'm glad we did. But had there been more of a suggestion the issue laid with my husband only instead of me, I would have paid the extra for it in a heartbeat.

My only point of showing the numbers was to show that it is still possible to conceive other ways with low morphology, so don't think you have to jump straight to IVF but again it's such a personal decision.

I think you brought up some excellent points on what to ask the RE's office for specifically on what's causing the defects for each person and what is the best course of action.

 

[abennion]

Just checking in to see how you are doing and to possibly give you some hope of how little morphology really affects the ability for fertilization since it's so subjective. Anyway we just finished our first IVF round and even though my husband's morphology was only 3 percent the doctors said we didn't need ICSI, since his count and motility were all good. So we decided to save the money. Out of 11 mature eggs, 9 fertilized naturally without ICSI (which is above the 60 percent normal fertilization rate during IVF). So a low morphology shouldn't really impact your odds of success at all. It really depends on the other factors.

How did your appointment go?

I don't know why I only saw this response now.

Our appointment went well. We are now in the IVF program, and I am start my stims tomorrow. Hopefully, if all goes well, we should be looking at a September BFP. Congratulations on your numbers! I hope everything turned out for you!

 

[BronteForever]

Yay, how exciting. Good luck as you go through the stimming process! Wow - you might be pregnant before you know it. Keeping my fingers crossed this works for you!

Actually none of my 9 embryos survived sadly, but that's all because of my egg quality issues. So we are trying to increase egg quality in the next few months and doing another cycle in January.

 

[abennion]

I'm sorry to hear, that must have been heart breaking. Good luck with round two in January though! Hopefully there will be a better outcome then.

 

[BronteForever]

It was pretty heartbreaking primarily because I wasn't expecting it. Almost all of my issues are tubal related, but I am almost 36 so I knew at least half would be bad eggs because of that but we were a bit shocked none of them made it to a viable embryo for transfer or freezing.

Luckily we did a package deal at our clinic so that helps. Just really hoping acupuncture and supplements will somehow help. I'm not overly optimistic but it's worth another chance. Plus we will be switching up the protocol slightly since my doctors focused way too much on quantity instead of quality this time around which was obviously the wrong choice. Hopefully we have better luck next round.

Hopefully you'll keep us updated as to your progress.

 

[Northernmonke]

Look into imsi also. 4 icsi didn't work for us 1 imsi did and gave us twins and 2 in the freezer