ICSI vs IVF

I'm confused about ICSI vs IVF. You say "ICSI is used when the fertility problem is a result of sperm disorders. These can include a low sperm count", but then go on to say "ICSI is recommended for patients who have had previously had failed fertilisation with IVF". Is there a reason ICSI is not used as a first treatment? Is there a particular low sperm count threshold where ICSI would be used first? Would you allow a patient to choose to pursue ICSI as a first option? Why or why not? Also, is it only failed fertilization attempts via IVF that prompt the use of ICSI? If a patient has repeated successful fertilisation but failed implanatation, would ICSI be tried, or would this not help? I'm thinking particularly in the case of male subfertility in a couple under thirty, if that makes a difference. Also, I read that ICSI has a slightly better live birth rate than IVF (something like 30% vs 28%). Why is this? Thanks!

Our Expert's Answer

This information was published 8 years, 6 months ago and was correct at the time of publication. It may not reflect our current practices or regulations.

Please note that all the answers we give are on a generic basis only, as we cannot provide more in-depth answers without access to your medical history. If you need a more detailed response, tailored to you, we would recommend a consultation with one of our Fertility Specialists for more comprehensive medical advice.

ICSI was developed as a technique to assist in the fertilisation process for male factor infertility. We would advise patients to have IVF in the first instance if the semen parameters are normal. The reason for this is that ICSI carries a slightly higher risk of birth defects in children compared to IVF.

We would recommend ICSI for a patient if the sperm count was less than 10million/ml if all other parameters were normal or 20million/ml if the other parameters such as motility or morphology were reduced. If a patient asked for ICSI we would have a detailed discussion looking at their individual situation and discussing all the benefits and risks involved.

We have used ICSI in cases where there has been repeated low fertilisation with IVF but there is no evidence that ICSI can overcome repeated failed implantation, especially if fertilisation is high. If a patient has had good fertilisation but repeated failed implantation we would look in great detail at the embryo quality and may suggest growing the embryo to the blastocyst stage to check the development is normal.

It is unlikely that ICSI is statistically more successful that IVF and the main factor is due to the age and egg quality of the woman. Hope that helps.