Ask the Doc: Our infertility is classified as unexplained. Should we use ICSI?

Question

My wife and I are currently going through IVF and we’ve been reading about the use of ICSI (intracytoplasmic sperm injection). I have not been diagnosed with any particular problem, and our infertility is classified as “unexplained”. Should we use ICSI?

Answer

ICSI follows the same process as IVF (in-vitro fertilisation), except ICSI involves the direct injection of a single sperm into each egg to achieve fertilisation.

ICSI is usually the preferred treatment for couples with confirmed male infertility, such as low sperm numbers, low sperm motility, abnormal sperm shape, blockages, and less common conditions, such as sperm antibodies. ICSI can also be used for couples with unexplained failure in previous IVF cycles.

Around one in 7 couples that require artificial reproductive treatment (ART) have “unexplained” infertility and doctors often first use approaches like ensuring the female partner’s ovulation occurs at the same time as natural sex or artificial insemination/intrauterine insemination (IUI). They may then recommend IVF where thousands of the male partner’s best sperm are purified and incubated with the egg — this is the preferred initial ART procedure in cases of “unexplained” infertility.

While ICSI is a more invasive procedure, some have suggested it may help by reducing the risk of failed fertilisation. However, it’s emerging that IVF is probably the preferred treatment, at least in the first cycle, in “unexplained” infertility. IVF allows for healthy competition between sperm, is less expensive, avoids trauma to the egg and may produce more embryos, with better pregnancy and live birth rates  

ICSI is not the first stepping stone in ART for “unexplained” infertility, however it’s important to ‘keep it up ones sleeve’, in case there’s a need for it after trying the other approaches mentioned above.

Robert McLachlan

Healthy Male Medical Director

Prof Robert McLachlan is a consultant andrologist and has been integral to Healthy Male from its inception as Andrology Australia in 2000. He has been Medical Director since 2006. In November 2020, Rob was awarded Life Membership of the Endocrine Society of Australia. Over his 30-year career, he has been passionate about educating doctors and the community about male reproductive health, particularly to normalise discussion of sensitive topics and to encourage men to seek help from their GPs. A past president of the Fertility Society of Australia, he has a strong connection in fertility practice and has raised the profile of infertile men involved in IVF. Rob has received several awards for his clinical research and was appointed a Member of the Order of Australia (AM) in 2016 for services to medicine in the field of endocrinology.

Keywords

Fertility
ICSI
Infertility
IVF

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