Intracytoplasmic sperm injection - ICSI

With the advent of intracytoplasmic sperm injection (ICSI), our programme noted a drop in the number of couples using donor insemination (DI) for severe male factor infertility. Over the first 8 months in which our infertility programme offered both treatments, 27 consecutive couples scheduled for ICSI and 15 consecutive couples scheduled for DI were evaluated Since all patients in our infertility programme beginning in-vitro fertilization (IVF) with planned ICSI or starting DI undergo a semi-structured psychological interview, the psychologist's clinical notes as well as the medical chart were reviewed and coded retrospectively to determine factors related to a couple's treatment choice. Couples who chose IVF-ICSI over DI had a higher occupational status and included husbands with higher educational levels. Their most common motivation was to have the husband's biological child (93% of couples in the ICSI group). The most common motivation for choosing DI (60% of DI couples) was that IVF was not financially affordable. Choice of treatment was not related to psychological adjustment, the husband having prior biological children, or his risk of passing on a genetic defect to offspring. These preliminary data raise the concern that, with the success of ICSI, DI may change in the USA from being an option dictated by semen quality to a second choice treatment utilized for economic reasons.

Please click on the required question.

• 1 What are the objectives of infertility treatment?
• 2 Why have I been advised to take folic acid as part of my infertility treatment?
• 3  Although my ovaries have eggs in them, my tests show that I am not releasing them (anovulation) and this is causing infertility. How can this be treated?
• 4 If I take drugs to induce ovulation (ovulation induction) for my infertility, are there any risks?
• 5 How is ovulation induction treatment for infertility monitored?
• 6 How does clomiphene citrate work for infertility?
• 7  How effective is clomiphene in the treatment of infertility?
• 8 Could I experience any problems whilst taking clomiphene?
• 9 Is there any advantage in having an injection of HCG to ensure ovulation?
• 10 How does tamoxifen work?
• 11 How can hyperprolactinaemia be treated?
• 12 How does metformin work?
• 12A How does letrozole work for infertility?
• 13 How do gonadotrophins work?
• 14 What are the risks for me if I receive gonadotrophin therapy?
• 15 What are recombinant gonadotrophins?
• 16  What is ovarian hyperstimulation syndrome (OHSS)
• 17 How is ovarian hyperstimulation syndrome treated?
• 18 How does electrocautery (ovarian drilling) work for infertility associated with polycystic ovary syndrome (PCOS)
• 19 I have been found to have endometriosis. How should this be treated to improve my chance of conceiving?
• 20 Tests have shown that I have problems with my Fallopian tubes. What can be done about this?
• 21 I have fibroids. How should these be treated to improve my fertility?
• 22 My post-coital test has shown that my mucus is stopping the sperm from swimming (mucus hostility). What can be done?
• 23 When can intrauterine insemination (IUI) improve our chance of achieving a pregnancy?
• 24 What is in vitro fertilisation (IVF) and embryo transfer (ET)
• 24A IVF single or double embryo transfer?
• 25 What is intracytoplasmic sperm injection (ICSI)
• 26 How do tubal surgery and IVF compare?
• 27 What are egg donation and egg sharing?
• 28 What is selective embryo transfer?
• 29 Investigations have shown no obvious cause for our difficulty achieving a pregnancy. Are there any treatments for our unexplained infertility?
• 30 We have tried a variety of treatments but we still have not achieved a pregnancy. Why should this be?
• 31  We are finding the investigation and treatment of our fertility problems to be ever more stressful. Can stress be a cause of infertility?
• 32 How can we determine which fertility unit is likely to be the best for us?
• 33 Where can I obtain more information?
• 34 Support Groups.
  

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.