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Infertility/Fertility/Higher fertilization on conventional vs ICSI

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QUESTION: Dear Dr. Ramirez,

We just completed our first egg retrieval for IVF yesterday.  We are Diagnosed unexplained and elected to do 50/50 conventional/icsi fertilization to see if fertilization was our problem. 23 eggs were collected yesterday and divided 12 for ICSI and 11 Conventional.  My RE told me that when doing conventional they have no way to tell if an egg is mature or not but when doing ICSI - because they clear away the outer shell the can tell if they are mature or not.

ICSI group:

9 of the 12 were deemed mature so they attempted fertilization of those 9.
2 degenerated post fertilization and 3 fertilized normally. That is like a 33 percent fert rate for ICSI when the norm is 60-70 percent

Conventional group:

11 were attempted to fertilize conventionally.
Of those 11, 7 fertilized normally, 1 fertilized abnormally.

So all together we have 10 embryos- 3 from ICSI and 7 from conventional. Our RE was pretty surprised by the fact that conventional did much better.

We did the antagonist protocol and on the day of hcg trigger my E2 was 3031.  Do you have any thoughts as to why we had such a poor fertilization using ICSI? We do not have male factor infertility. Is the sign of poor fertilization using ICSI a sign of poor egg quality? I stunned so easily and well that I can't imagine it is that but a friend did some research and told me it may be a sign of poor egg quality.

ANSWER: Hello Sunny from the U.S. (D.C.),

I cannot tell you exactly why the ICSI group did so poorly but the natural fertilization group showed that there is not a fertilization problem.  Therefore, the only possible explanation is laboratory technique.  Because ICSI is where the sperm is injected into the egg, eggs can be damaged if the ICSI technique is not good.  Of course, this is conjecture, but an ICSI fertilization rate of under 60% is not normal, and the higher natural fertilization rate shows it was probably not an egg or sperm problem.  Therefore, the only possible explanation is ICSI technique.  Keep in mind that this explanation is based on deduction and NOT based on fact since there is no way for me to know what happened with any certainty.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

---------- FOLLOW-UP ----------

QUESTION: Thanks so much for having sent such a prompt response Dr. Ramirez.  I cannot begin to tell you how much it calmed me down as I was truly scared that I would get a call the following day that all my embryos were lost.

I just wanted to briefly update you given how kind you were to reply so quickly.  As of Day 3 all 10 embryos were still with us (we didn't lose any) so they elected to do a 5 day transfer.  2 were 8-cell; 3 were 7-cell; 1 was a 6-cell; 3 were 5-cell; and 1 was a 4 cell.

On Day 5 - all 10 were still with us, 2 were blasts and 3 were in the cavitating stage I was told.  We transfered the two blasts (one Grade A and one Grade B).  We received a call a few days later that they were able to freeze one additional blast - but I haven't received the report on its specifics.

Thanks again for all of your help with this and all the other questions you have responded to from me in the past year or so.

With warmest regards,

Sunny

Answer
Hello Again

Well that is fantastic news.  I will pray that God blesses you with the Gift of a child.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate  

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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