ICSI success rates
5 Replies
scout - December 11

Hi Dr. Smith,
Thank you for your giving such thorough answers to everyone's questions. I've spent many hours reading through old posts and getting lots of valuable info.
In one of the old posts, you stated, "If ICSI is performed for severe sperm problems, the success rate is quite low."
This scares me. What exactly does "quite low" mean? What is the basis for this statement?
I have just had one round of failed ICSI (for very poor sperm morphology and borderline counts and motility). We are trying again. We are doing this under the advisement of our RE who said that ICSI "bypasses any sperm issues". He has basically led us to believe that we have as good a chance as anybody doing IVF without ICSI... better in fact, as I am (relatively) young and have no known issues on my side, and, as he says, ICSI "takes care of" all of the male factor issues. He says we have at least a 50% chance... that isn't exactly 'quite low'. Please explain. Thank you so much.


Dr Smith - December 13

ICSI is a work around for fertilization problems, but it is not a panecea for all sperm problems. From your description, your husband doesn't really fall into my definition of "severe" sperm probelms. So, take a deep breath and relax. Some examples of "severe" sperm problems would be 0% normal morphology on two or more SAs, extremely low numbers of sperm (i.e. < 1000 in the entire ejaculate) or using testicular or poor quality epididymal sperm. ICSI can overcome problems with fertilization, but when the problem is "severe" the sperm are often genetically abnormal. Although you can achieve fertilization, the abnormal genetics of the sperm results in fewer embryos reaching the blastocyst stage and a higher first trimester miscarriage rate.

I agree with your RE (although he is naive about effect of sperm problems) that your chances are reasonable. The main problem in your case appears to be achieving fertilization. ICSI is the work around of choice in your case. Best of luck.


scout - December 13

Thank you for clearing things up. However, the bad news is... he has had 0% morphology on 2 SAs. Sometimes it is 1 or 2% (we tried several IUIs before this). We asked what it was when they did the ICSI, but they said they don't measure it then, they just look for the "best looking" sperm to inject. I know this may be an impossible question to answer, but how much does this morphology issue decrease our chances of not only pregnancy, but making it beyond the first trimester? Also, does this seem like we should push for the 5 day transfer (they did a 3 day last time. After that they let the rest sit for 3 more days... one made it to freeze... I can't help but wonder if the 2 they put in would have made it that long?)
I'm very frustrated with my RE and the embryologist as they often give us very vague information ("The embryo looked nice" when I asked abou the grading of the frozen embryo-- I laughed and asked if 'nice' was the technical term), and seem to dismiss any of my questions about how the sperm issues will affect our chances. They said morphology is just the packaging, what is inside is perfectly fine.
We are going financially and emotionally bankrupt to try this another time. I want to be fully informed so that if we decide to move on to donor sperm or adoption after this, I'll know we've done the right thing.
Thank you again.


Dr Smith - December 13

If morphology is only packaging, why does vey poor morphology lead to higher micarriage rates, particularly when very poor morphology is combined with other sperm problems like poor motility?

Sperm morphological assessment based on strict criteria and in-vitro fertilization outcome. Kobayashi T, et al. Hum Reprod. 1991 Aug;6(7):983-6

The relationship between sperm morphology and rates of fertilization, pregnancy and spontaneous abortion in an in-vitro fertilization/intracytoplasmic sperm injection programme. Lundin K, et al. Hum Reprod. 1997 Dec;12(12):2676-81.

Sperm morphology is not just "packaging" and there is a way to find out if the DNA inside the head is O.K. or not. It is called the sperm chromatin structure assay (SCSA). This test evaluates the integrity of the sperm DNA and has some predictive power in terms of fertilization and early miscarriage. For more information on this relatively inexpensive test, go to www.scsadiagnostics.com/MoreInform

it is NOT routine to evaluate morphology on the day of IVF. I do, but I think I'm an exception to the rule. I want to know if the morphology is bad or not so that I can decide whether or not to do ICSI. The sperm "du jour" may be different from previous SAs.

Vague answers are all part of the game. Since, in many cases, the RE or embryologist doesn't know enough to give a specific answer, the answer is vague (instead of coming right out an saying "I don't know"). Me, I just say I dunno, 'cause I don't. If I'm guessing, I'll say so.

If you are only going to try this one more time (did I hear someone say second mortgage?), I'd recommend deciding whether or not to use your husband's sperm based on the results of the SCSA. If its abnormal (or even subfertile), I'd go with donor sperm, provided this option is acceptable to your husband. No matter what the sperm source is, I would suggest culturing the embryos to the blastocyst stage (yeah, I know folks, no surprise there). A higher number of embryos arrest development prior to reaching the blastocyst stage when sperm morphology and motility are poor. If you wait until the embryos reach the blastocyst stage, at least you will know that the embryos are capable of implantation. With Day 3 transfers, you just don't know that for sure and, if it doesn't work, that ends up in a lot of unanswered questions.


Blue - June 12

Hi Dr. Smith.
Your responses to Scout have left me a little confused in regards to my own situation. Hopefully you can shed some light on our predicament. First of all, we are located in Canada, Toronto to be exact. Apparently, my husband has been seen by the best urologist in Canada, specialized in male infertility. He has had 2 testicular surgeries to identify the issue; a biopsy and an exploratory procedure. He completed 5 sperm analyses, 2 of which where sperm was found and frozen for future IVF usage. We followed the urologist's recommendation and paid for the following tests: Y-micro deletion and Klinefelter Syndrome test. Both came back normal. Essentially, we were told that my husband's sperm is "low & intermittent". However, he was optimistic that our chances at IVF with ICSI would be good, since we had frozen sperm and were lucky to have avoided the need for a micro-tese. We were told that the frozen sperm looked good in terms of maturity. My husband is 37 years old and I am 35. I responded very well to the ovarian stimulation. My IVF doctor was very confident in our situation. At my retrieval, 8 eggs were found, 5 of which were mature. 24 hrs later I was informed that 3 looked like they were developing; however, fertilization was not clearly definitive. At 48 hrs, I was informed that they had arreted. Hence, we had no fertilization occur from the 5 eggs that were retrieved. We were all dumbfounded by this outcome. My IVF doctor has recommended that we return to the urologist to discuss this outcome and see if there is anything he can suggest. It is apparent that the IVF doctor believes that the sperm was the issue in the lack of fertilization. Now that I've explained our history and current situation, I wonder if you have any ideas as to why our specialists never recommended the SCSA test or IMSI. I have only learned of these two options via message boards. They were never mentioned to us. Are these options only available in the USA? We were told that selecting sperm for IVF based on morphology is not possible. Do you think SCSA and IMSI would help us achieve a pregnancy? Thank you for your time.


James - June 16


SCSA is definatley available in Toronto. We had one done at the Hanam Fertility Clinic at Bay and Elm in Toronto. Think they outsourced it to a third party lab - but it was definately available.



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