ICSI Success Rates

ICSI (intracytoplasmic sperm injection) is a procedure that can be done in conjunction with IVF (in vitro fertilization) to increase its chances of success. In ICSI, a single, healthy sperm is injected into a mature egg using a very small needle. It is used to overcome male infertility. In cases where a man has a low sperm count, low sperm motility, or poor sperm morphology, ICSI eliminates the need for the sperm to find the egg by itself. A technician in a lab does the dirty work for it.

But how successful is ICSI? One must look closely at the statistics so as to be misled by the numbers. The success rate for ICSI is currently 70-80%. It is important to note that this is rate that the procedure results in fertilization of the egg only. After this part of the procedure is done you must still go through the embryo transfer and implantation portion of IVF which, as we know, has a much lower success rate. Make sure you are reading the data as live birth rates vs conception rates. However, the good news is that the success rate for IVF when done with ICSI is slightly higher than when done without. This is 25-25% in women under 35.

Of course there are other factors that determine the success rate of ICSI, and none more prevalently than the experience and expertise of the clinic and technician performing the procedure. Compared to IVF, this is a relatively new procedure so we just don’t have as much long-term data yet for it. But the techniques are improving all the time and as the knowledge and understanding of the science grows, so will the success stories

IVF and Insurance Coverage

As we talked about in our section on the cost of IVF, it is an expensive process. Unfortunately, the cost is prohibitive for some couples. Currently there are 15 states that mandate employers (of over 25 people) to offer coverage on their health plan for fertility diagnosis or treatments. They are: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. Of these states, California, Louisiana and New York require coverage of fertility treatments, but specifically exclude IVF. Unfortunately, in states that are not mandated to offer coverage, insurance for IVF treatments is hard to find and plans can be expensive and of a limited scope. Whether you live or work in one of these states and are covered under an employer’s plan, or are seeking to purchase supplemental coverage on your own, we want to offer some tips and things to look out for as you navigate these murky waters.

  • Is there a waiting period on your policy?
    Some policies will state that you must pay the premium for a certain amount of time before you can seek the benefits. Read the fine print and plan accordingly.
  • This may seem obvious, but make sure that the woman is the one explicitly named as the beneficiary of the plan. She will be the one undergoing the bulk of the procedures.
  • Are drugs covered?
    The drugs are a HUGE portion of the total cost of IVF.
  • Are office visits covered?
    These will factor into the total cost.
  • Is pregnancy covered?
    If you do not have pre-natal or maternity coverage on your current plan, you may be able to add this in.
  • As with any insurance plan, take a look at the cost. What is the deductible versus the premium?
    Lower monthly payments will mean higher out of pocket costs at the time the benefits are used. Figure out what fits in your monthly budget.
  • As mentioned above, check the verbiage of the plan to see what fertility treatments are covered. Fertility injections? IUI? Costs associated with donor egg or sperm?
  • Even in the states where coverage is mandated, some will pay for testing for infertility, but will not pay anything further once a diagnosis is made. More fine print.
  • Where is your company headquartered?
    If the state where your employer has its headquarters is one that mandates fertility treatment coverage, you may be eligible. Contact your insurance company for details.
  • Even with insurance, it is common to see a maximum lifetime coverage of $10,000-$25,000. Even at the high end of this range, only one IVF cycle will come close to being covered. If your first cycle results in a successful pregnancy then that is great! If not, you may find yourself paying out of pocket for another attempt.
  • IVF may be tax deductible! Any medical expense may be tax deductible in an amount over 7.5% of your Annual Gross Income (AGI). Keep vigilant records of the expenses you incur during the process: doctor visits, hotel stays, mileage, etc.
  • More on tax deductions: You cannot claim any portion of the expenses that were paid for through a Flexible Spending Account, as this money is already tax-free. Contact your tax specialist for details.
  • Also keep in mind for tax deductions: You will only want to claim the expense for deductions if it is above the total for the standard deduction for your tax category. In cases of IVF this is not typically an issue. Contact your tax specialist for details.
The most important thing you can do when starting the IVF process is BE INFORMED! Do your homework. This is the most important decision you are likely to have made at this point in your life (and one of the most expensive!). There is money to be found out there to help you if you need it. Don’t be afraid to dig, but protect yourself in the process.
We hope you find this information helpful. Remember, talk to your fertility specialist and contact your insurance company to discuss your options.

What is IVF

In Vitro Fertilization (IVF) is the process in which insemination and fertiization between egg and sperm take place outdside the body in a laboratory. The fertilized embryo is deposited into the woman’s uterus via catheter in a process called embryonic transfer. The desired result of an IVF cycle is successful implantation and the beginning of a healthy pregnancy.

Infertility is defined as the inability to become pregnant after 1 year of unprotected sex, 6 months if over the age of 35. For many couples, the decision to use IVF to start or grow their family comes after months or even years of struggling with infertility.

The journey starts with a visit to the OB/GYN or primary care physician and then to a Reproductive Endocrinologist or fertility specialist. First steps include attempting to improve fertility using hormone treatment, medication or minimally invasive procedures. Intrauterine Insemination (IUI), in which sperm is placed inside the uterus to facilitate fertilization, is typically attempted before going with the fully assisted reproductive method of IVF.

Deciding to try to conceive through IVF is a big decision, as the procedure is more invasive than other methods, and the emotional and financial impact is much higher. However, the reward can be great, and we want to help make the process more clear and eliminate some of the fear that comes with the unknown.

There are 6 basic steps to In Vitro Fertilization:

Step 1: Ovarian Stimulation

Fertility drugs are prescribed to stimulate the ovaries into producing multiple eggs on the desired schedule. There are varying levels of hormones used in conjunction with a woman’s natural menstrual cycle to achieve this step. Some of the medication will be given by injection, administered by you and/or your partner at home. During this process, a woman will undergo frequent ultrasounds and blood tests to see how the ovaries are responding to the hormones.

Step 2: Egg Retrieval

When the eggs have reached full maturation they are ready to be retrieved. This is done through a minor surgical procedure using an ultrasound-guided needle to pierce the vaginal wall to reach the ovaries. This process is called follicular aspiration, and is done under conscious sedation or general anesthesia.  Ideally, at least 12-15 eggs are retrieved. This is a short procedure, lasting around 20 minutes, and may result in minor abdominal cramping and light spotting.

Step 3: Sperm Collection

On the day of egg retrieval the sperm is collected through ejaculation or testicular aspiration. It is then put through a process called “washing” to remove inactive sperm and seminal fluid and isolate the best candidates for fertilization.

Step 4: Fertilization

The sperm and eggs are incubated together, and after 12-24 hours are inspected for signs of fertilization. In 70% of cases, the egg will be fertilized during this process. In cases of male infertility resulting from low sperm count or motility, a procedure called Intracytoplasmic Sperm Injection (ICSI) is used. Here, an embryologist will inject a carefully selected healthy sperm directly into the egg using a thin needle. When fertilization occurs, the egg is transferred to a special incubator and monitored closely for 2-5 days until it consists of 6-8 cells.

Step 5: Embryonic Transfer

In this phase, a predetermined number of embryos are transferred into the uterus. This is done through a thin catheter inserted into the uterus through the cervix. This procedure is typically not done under anesthesia. After the transfer, the patient will lie on her back for a couple of hours before going home for more rest.

Step 6: The Waiting Game

Even with all of the injections, exams and procedures you’ve endured in the IVF process, this last step can be the hardest. Now you will rest and look for early signs of pregnancy. This is known as the “Two Week Wait”. Within these two weeks after the transfer, you will take a pregnancy test. This will be a blood test administered by the doctor. They will also test progesterone levels at this point, and possibly over the next few days.

If the test is positive, you will continue to be monitored closely throughout the early pregnancy. While women who conceive naturally will have only a few ultrasounds throughout pregnancy, you will have them very frequently, especially in the first trimester.

If the test is negative, you and your partner will need to make a decision as to how you will proceed. Remember, no one can make this decision except you.

Gender Selection

Today’s scientific advancements have made it possible to select the gender of your child. Embryologists are now able to create or identify embryos of a certain sex. The ability to do this grew out of procedures already in place to perform genetic testing for medical reasons. It has only recently been opened up to non-medical, elective reasons such as “family balancing.” Cost, eligibility requirements, and moral or ethical conflicts make this not for everyone. We’ll go through some of the details in this article so you can see what options are available out there.Gender Selection & PGD

Pre-Implantation Genetic Diagnosis (PGD)

In this procedure, embryos created through IVF are tested for genetic disorders and gender. It was introduced in 1989 solely as a way to help couples with genetic disorders reduce the risk of having a child with the same condition. It is still widely used today for this reason, and also for women over 35 with a history of miscarriages. The testing will select embryos that are most likely to implant and result in successful pregnancy. Very few (literally only 3 or 4 in the US, and almost none overseas) will perform PGD for non-medical sex selection.

The Procedure

A cycle of pre-IVF fertility medications, egg retrieval, and in vitro fertilization is done. The embryos undergo genetic testing before implantation, rather than just a microscope check as is done in a normal IVF cycle. The embryologist will determine the health of the embryo, any potential genetic abnormalities, and gender. At this point, a decision will be made as to what to do with the information you receive. In PGD, only two embryos will usually be transferred since the weaker ones have already been selected out.

Pros

PGD is almost 100% effective in selecting embryos of the desired gender for implantation. Just like IVF, you will have the ability to freeze embryos for later implantation and save the cost.

Cons

The procedure can cost of up to $20,000. Like the cost, it shares many of the same negatives of IVF—invasive procedures, medications, risk of multiples. Perhaps the hardest thing about undergoing this procedure for the purpose of gender selection is that you have to decide what to with the embryos of the unwanted gender. Even if you are certain that you want a boy or a girl, this can be a very difficult decision. Will you freeze them for later, destroy or donate them?

MicroSort

In this procedure, instead of selecting the already fertilized embryos by their sex, the male and female producing sperm are separated and then the desired gender producing sperm are inserted into the uterus using intrauterine insemination (IUI).

The Procedure

This procedure is based around the X chromosome having about 3% more DNA than the Y chromosome, and therefore the sperm cells containing the X chromosome being bigger. A sperm sample is colored with dye and illuminated with a laser. The bigger female-producing sperm will glow brighter than the male-producing sperm, as they have absorbed more dye with their bulkier selves. The sperm is then separated by sex and the desired gender sperm are transferred to the uterus via IUI. Microsort can also be used with IVF, but would only do so in infertility cases where IVF was required. The practitioners of this method claim that it is 90% effective in choosing girls, and 74% effective in choosing boys.

Pros

Microsort can be used to prevent transmission of X-linked disorders (those that women can pass to buys but not girls), such as hemophilia. Because this procedure does not require that IVF is used (unless it is necessary for fertility reasons), you do not have the costs or risks associated with the much more invasive procedure. You will also not have to decide what to do with extra embryos.

Cons

Microsort is not approved by the FDA. It very recently (Spring 2012) failed to pass the clinical trial portion of testing to achieve this approval. It is therefore not currently available in the US. Prior to this restriction, there have been around 500 babies born in the US whose gender was selected by Microsort. It is a very new procedure (first available in 1995) and as such, the risks are not yet known. And of course, it cannot guarantee gender because we are unable to completely exclude all of the sperm on unwanted gender in a semen sample.

Ericsson Method

This method of gender selection is named for the doctor who developed it, Dr. Ronald Ericsson in 1970. It is based on the theory that male producing sperm swim faster than female-producing sperm. Ericsson claims that the procedure is 78-85% effective in choosing boys and 73-75% effective in choosing girls, many in the medical community doubt these numbers.

Procedure

A semen sample is poured through albumin in a test tube. As the sperm naturally swim down, it is observed as the male sperm reach the bottom faster. Slow and fast swimmers are separated out and the desired sperm in introduced in the uterus or cervix via IUI or ICI. If the desired sex of the baby is female, then the woman is also given Clomid in conjunction with the procedure as it is shown to increase the chances of having a girl.

Pros

This is a much less expensive procedure, costing around $600. It is non-invasive and relatively safe. It is also more available, even in states where there are restrictions on gender selection procedures.

Cons

There is no guarantee of success. The claims of its effectiveness are disputed and some research says it is no higher than 50%.

 

There are many techniques that people have used for years to try and control the sex of their unborn baby. Everything from diet, sexual positions to the timing of intercourse is commonly used. Here are some of them:

Shettles Method

This method suggests scheduling intercourse on specific days of your menstrual cycle to get a desired gender. According to the theory, male sperm move faster but don’t live as long as female sperm. In order to have a boy, you should have sex as close as possible to ovulation. If you want to have a girl, then have sex 2-4 days before ovulation so that it is the girl sperm that is still around when you ovulate.

Another theory of the Shettles method says that more acidic environments are harmful to the male sperm, but do not affect the female sperm in the same way. Shallow penetration (and the sexual positions that best facilitate this) favors female conception because the area is more acidic, inhibiting the weaker male sperm. Conversely, deep penetration will deposit the faster swimming male sperm closer to the uterine opening where it is less acidic and will better its chances of out swimming the slower female sperm. Also, female orgasm is said to make the environment more conducive to male conception as it makes it more alkaline.

The claims are of 75-90% effectiveness, but they are widely disputed.

Whelan Method

This method also suggests scheduling intercourse on specific days of your menstrual cycle to get a desired gender. The Whelan method directly contradicts the Shettles method. It is based on the theory that chemical changes that may favor male sperm occur earlier in the menstrual cycle. If you want to have a boy, have sex 4-6 days before you basal body temperature (BBT) goes up at the start of ovulation. If you want a girl, wait to have sex 3 days before ovulation.

Dr. Whelan claims only 68% effectiveness in conceiving a boy, and 56% effective in conceiving a girl.

Sex Selection Kits

Yes, you can get an at home kit for everything! These are gender-specific kits based on the Shettles method. They include: A basal thermometer, ovulation predictor sticks, douches to prepare the vaginal environment, and vitamins and herbal extracts. These kits cost about $200 from several online sources and thousands have been sold across the US. These sources claim success rates of between 78-96%, but this is heavily disputed by the medical community.

Bottom Line on Gender Selection

This is a subject that is becoming increasingly controversial as we continue to make great strides in scientific research. As we acquire the knowledge and then the ability to do more and more, issues arise as to what and how we are to use that knowledge. Although many believe that any embryonic genetic testing is above and beyond our rights as humans, the main controversy here is the use of such technology for non-medical gender selection. To many of us who are struggling with infertility and clinging to that hope of someday conceiving a child, the thought that one sex is preferable to another is unthinkable. But the issue is out there, and it is only going to become more and more prevalent as the science gets better and more advanced. You and your partner will know what is right for you. There is plenty of information out there to read and to be informed about the options available to you.