My hubby and I have beeen trying to conceive for three years he is age 40 and I age 34 he does sometimes seem to have a hard time geting it up!!! but it does explain some things that we didn't know anything about!!I have 3 kid's age 16 a girl & a boy age 14 & my youngest he's 5 yrs. old but my hubby has never had any kid's and so we keep on trying!!! Tammy
The Male Biological Clock
June 25, 2007
Say "biological clock" and most people immediately think "women." Female fertility, after all, strikes "midnight" with the cessation of menses. This occurs because of distinct—and dramatic—declines in estrogen production. And as women age, the genetic quality of their eggs and the efficiency with which their bodies reject genetically damaged embryos both decline, leading to an increased risk of genetic problems in their offspring. This triad of declining fertility, declining hormone levels, and increasing risk for genetic problems is what most people mean when they say "biological clock."
Until recently, that is. Although it's an idea that has not yet filtered down to the general public, we now know that men have biological clocks too. And those clocks involve the same physiological triad experienced by women. Male fertility and male sex hormones do decline with age. And the genetic quality of sperm does decline, leading to an increased risk of genetic problems in offspring above and beyond any contributed by the female. The object of this review is to describe these features of male aging and, hence, to expand the notion of "biological clock" to include both sexes.
Data obtained in the past decade suggested a worldwide decline in male fertility. Although initially thought to be the result of external variables such as exposure to pollution, we now understand a real culprit: men are simply waiting longer to have children and aging is adversely affecting their fertility. It is well known that women are waiting longer to have children. Data from the Centers for Disease Control (2001) clearly demonstrate that over the last 30 years there has been a decline in the number of children to woman under the age of 30 with a corresponding increase in the number of children born to women over 30. In fact, the largest increase has been the more than doubling of the number of births to women over the age of 35. In 1970 the number of births to such women was 6 percent. That increased to 13 percent in 1999 and is undoubtedly higher now. What is less often discussed, but hardly surprising, is that there has been a parallel increase in paternal age. There was a 50 percent increase in fathers older than 35 in the past 30 years.
The increase in paternal age is both a personal problem for many couples and a public health problem because of the simple (but still largely unrecognized) fact that male fertility declines with age. Journal articles by Kidd et al. (2001) and Ford et al. (2000) demonstrate that men over the age of 35 are twice as likely to be infertile as men younger than 25. In addition, a study of couples undergoing fertility treatments with intra—uterine inseminations found that the amount of time it takes for a man to achieve a pregnancy rises significantly with age. After controlling for maternal age, men older than 35 had a 50% lower pregnancy rate than men younger than 30 (Mathieu et al 1995). Although further epidemiological research is needed to prove the point, this pattern of rising difficulty to achieve pregnancy likely holds true for the male population in general. The bottom line: current reviews of controlled studies looking at male aging show robust positive correlations between age and infertility as well as age and the time required to achieve pregnancy.
As with women, the levels of sex hormones in men declines with age. The drop is not as steep or as sudden as that associated with menopause, but it can be equally significant for fertility and overall well—being. In fact changes in men's hormones are just as important as changes in women's hormones. The roughly 1 percent per year decline in testosterone levels after age 30 has been termed "andropause," though this is a somewhat unfortunate choice because testosterone levels don't actually "pause" in the same way that estrogen levels do. A more technically accurate (though clumsy) term is "symptomatic hypogonadism in the aging male." Whatever you call it, declining testosterone causes problems. Rhoden and Morgentaler (2001) estimate that between 2 and 4 million men in the US alone suffer from hypogonadism (defined as serum total testosterone levels lower than 325 ng per deciliter). The same article found that only 5 percent of these men are getting treatment for their symptoms, which include decreased libido and erectile dysfunction, loss of muscle mass and strength, weight gain, and declining cognitive function. Hypogonadism is also associated with type II diabetes, insulin resistance, central obesity and the metabolic syndrome. Newer treatments for hypogonadism such as exogenous testosterone replacement and stimulation of endogenous testosterone production are gaining tremendous popularity. Sales of prescription testosterone products have soared more than 500 percent since 1993 and show no signs of leveling off (Bhasin & Buckwalter, 2001). This enormous increase is not without risks. Indiscriminate use of testosterone supplements can raise the risk for prostate problems, blood disorders, and infertility.
Although increasing maternal age has long been known to be associated with increased incidence of birth defects, the age of the male as been seen as irrelevant. New data show what we should have suspected all along: the age of the male does matter and the genetic quality of sperm does decline with age. Specifically, a 2004 study by Malaspina et al., found that older men are at higher risk of fathering a child with schizophrenia. In fact men older than forty were more than twice as likely to have a child with schizophrenia as men in their twenties. A 2003 study (Fisch et al.) found a similar influence of paternal age on the risk of having a child with Down Syndrome. Paternal age was a factor in half the cases of Down Syndrome when the maternal age was over 35. And a 2002 study by Rochebrochard and Thonneau of the rate of miscarriages found similar increased risks with rising paternal age when maternal age was older than 35. These and other studies clearly show that when the mother and father are both over the age of 35 years, there is a markedly increased risk of both genetic abnormalities and miscarriage. The father's contribution to these events is increased with increasing age, similar to women. As noted above, these facts are worrisome in light of the large increases in maternal and paternal age over the past 25 years.
This brief review demonstrates a still un—appreciated reality: men have biological clocks that affect their fertility, hormone levels, and the genetic quality of their sperm. This clock plays a role on a personal level (when couples must grapple with infertility or birth defects) and on a public health level (when society must decide policies governing, for instance, insurance coverage for advanced fertility treatments such as in vitro fertilization.) Women should no longer be viewed as solely responsible for age—related fertility and genetic problems. Infertility is not just a woman's problem and with the new awareness of a male biological clock couples and their physicians can much more accurately proceed with proper testing, diagnosis and (if needed) treatment of the male. The field of male—factor infertility is still young, and much more research is needed to fully characterize risks and to find more effective treatments. We also need to better understand the cellular and biochemical mechanisms of "gonadal" aging in order to find safe, effective ways to delay this process and, in effect, "rewind" the male biological clock. Doing so will lessen the potential for adverse genetic consequences in offspring, improve the sexual and reproductive health of aging males, and increase a woman's chance of having healthy children by correcting defects in the male reproductive machinery.
References:
Until recently, that is. Although it's an idea that has not yet filtered down to the general public, we now know that men have biological clocks too. And those clocks involve the same physiological triad experienced by women. Male fertility and male sex hormones do decline with age. And the genetic quality of sperm does decline, leading to an increased risk of genetic problems in offspring above and beyond any contributed by the female. The object of this review is to describe these features of male aging and, hence, to expand the notion of "biological clock" to include both sexes.
Male Infertility
Data obtained in the past decade suggested a worldwide decline in male fertility. Although initially thought to be the result of external variables such as exposure to pollution, we now understand a real culprit: men are simply waiting longer to have children and aging is adversely affecting their fertility. It is well known that women are waiting longer to have children. Data from the Centers for Disease Control (2001) clearly demonstrate that over the last 30 years there has been a decline in the number of children to woman under the age of 30 with a corresponding increase in the number of children born to women over 30. In fact, the largest increase has been the more than doubling of the number of births to women over the age of 35. In 1970 the number of births to such women was 6 percent. That increased to 13 percent in 1999 and is undoubtedly higher now. What is less often discussed, but hardly surprising, is that there has been a parallel increase in paternal age. There was a 50 percent increase in fathers older than 35 in the past 30 years.
The increase in paternal age is both a personal problem for many couples and a public health problem because of the simple (but still largely unrecognized) fact that male fertility declines with age. Journal articles by Kidd et al. (2001) and Ford et al. (2000) demonstrate that men over the age of 35 are twice as likely to be infertile as men younger than 25. In addition, a study of couples undergoing fertility treatments with intra—uterine inseminations found that the amount of time it takes for a man to achieve a pregnancy rises significantly with age. After controlling for maternal age, men older than 35 had a 50% lower pregnancy rate than men younger than 30 (Mathieu et al 1995). Although further epidemiological research is needed to prove the point, this pattern of rising difficulty to achieve pregnancy likely holds true for the male population in general. The bottom line: current reviews of controlled studies looking at male aging show robust positive correlations between age and infertility as well as age and the time required to achieve pregnancy.
Testosterone
As with women, the levels of sex hormones in men declines with age. The drop is not as steep or as sudden as that associated with menopause, but it can be equally significant for fertility and overall well—being. In fact changes in men's hormones are just as important as changes in women's hormones. The roughly 1 percent per year decline in testosterone levels after age 30 has been termed "andropause," though this is a somewhat unfortunate choice because testosterone levels don't actually "pause" in the same way that estrogen levels do. A more technically accurate (though clumsy) term is "symptomatic hypogonadism in the aging male." Whatever you call it, declining testosterone causes problems. Rhoden and Morgentaler (2001) estimate that between 2 and 4 million men in the US alone suffer from hypogonadism (defined as serum total testosterone levels lower than 325 ng per deciliter). The same article found that only 5 percent of these men are getting treatment for their symptoms, which include decreased libido and erectile dysfunction, loss of muscle mass and strength, weight gain, and declining cognitive function. Hypogonadism is also associated with type II diabetes, insulin resistance, central obesity and the metabolic syndrome. Newer treatments for hypogonadism such as exogenous testosterone replacement and stimulation of endogenous testosterone production are gaining tremendous popularity. Sales of prescription testosterone products have soared more than 500 percent since 1993 and show no signs of leveling off (Bhasin & Buckwalter, 2001). This enormous increase is not without risks. Indiscriminate use of testosterone supplements can raise the risk for prostate problems, blood disorders, and infertility.
Genetic quality of sperm
Although increasing maternal age has long been known to be associated with increased incidence of birth defects, the age of the male as been seen as irrelevant. New data show what we should have suspected all along: the age of the male does matter and the genetic quality of sperm does decline with age. Specifically, a 2004 study by Malaspina et al., found that older men are at higher risk of fathering a child with schizophrenia. In fact men older than forty were more than twice as likely to have a child with schizophrenia as men in their twenties. A 2003 study (Fisch et al.) found a similar influence of paternal age on the risk of having a child with Down Syndrome. Paternal age was a factor in half the cases of Down Syndrome when the maternal age was over 35. And a 2002 study by Rochebrochard and Thonneau of the rate of miscarriages found similar increased risks with rising paternal age when maternal age was older than 35. These and other studies clearly show that when the mother and father are both over the age of 35 years, there is a markedly increased risk of both genetic abnormalities and miscarriage. The father's contribution to these events is increased with increasing age, similar to women. As noted above, these facts are worrisome in light of the large increases in maternal and paternal age over the past 25 years.
The Male Biological Clock is Real
This brief review demonstrates a still un—appreciated reality: men have biological clocks that affect their fertility, hormone levels, and the genetic quality of their sperm. This clock plays a role on a personal level (when couples must grapple with infertility or birth defects) and on a public health level (when society must decide policies governing, for instance, insurance coverage for advanced fertility treatments such as in vitro fertilization.) Women should no longer be viewed as solely responsible for age—related fertility and genetic problems. Infertility is not just a woman's problem and with the new awareness of a male biological clock couples and their physicians can much more accurately proceed with proper testing, diagnosis and (if needed) treatment of the male. The field of male—factor infertility is still young, and much more research is needed to fully characterize risks and to find more effective treatments. We also need to better understand the cellular and biochemical mechanisms of "gonadal" aging in order to find safe, effective ways to delay this process and, in effect, "rewind" the male biological clock. Doing so will lessen the potential for adverse genetic consequences in offspring, improve the sexual and reproductive health of aging males, and increase a woman's chance of having healthy children by correcting defects in the male reproductive machinery.
References:
2001 Assisted Reproductive Technology Success Rates. U.S. Department of Health and Human Services, Centers for Disease Control. 2003. p. 11.
Bhasin S, Buckwalter JG. Testosterone supplementation in older men: a rational idea whose time has not yet come. Journal of Andrology. 2001;22:718—731.
E. de la Rochebrochard, and P. Thonneau. Paternal age and maternal age are risk factors for miscarriage: results of a multicentre European study. Human Reproduction, 17 (6), 2002, 1649—1656.
Fisch H, Hyun G, Golden R, et al. The influence of paternal age on down syndrome. Journal of Urology 169(6), (2003):2275—2278.
Kidd SA, Eskenazi B, Wyrobek AJ. Effects of male age on semen quality and fertility: a review of the literature. Fertility and Sterility. 2001;75(2):237—248.
W. C. L. Ford, K. North, H. Taylor, et al. Increasing paternal age is associated with delayed conception in a large population of fertile couples: evidence for declining fecundity in older men. Human Reproduction, 15 (8), 2000: 1703—1708.
Rhoden EL, Morgentaler A. Risks of testosterone—replacement therapy and recommendations for monitoring. New England Journal of Medicine 350 (2004):482—92.
Malaspina D., etal Advancing Paternal Age and the Risk of Schizophrenia Arch Gen Psychiatry.158:758, 2001
Mathieu, C., Ecochard, R.,Bied, V.,Cummulative conception rate following intrauterine artificial insemination with husband's spermatozoa:influence of husband's age. Human Reproduction 1995,10,1090—1097
2001 Assisted Reproductive Technology Success Rates. U.S. Department of Health and Human Services, Centers for Disease Control. 2003. p. 11.
Bhasin S, Buckwalter JG. Testosterone supplementation in older men: a rational idea whose time has not yet come. Journal of Andrology. 2001;22:718—731.
E. de la Rochebrochard, and P. Thonneau. Paternal age and maternal age are risk factors for miscarriage: results of a multicentre European study. Human Reproduction, 17 (6), 2002, 1649—1656.
Fisch H, Hyun G, Golden R, et al. The influence of paternal age on down syndrome. Journal of Urology 169(6), (2003):2275—2278.
Kidd SA, Eskenazi B, Wyrobek AJ. Effects of male age on semen quality and fertility: a review of the literature. Fertility and Sterility. 2001;75(2):237—248.
W. C. L. Ford, K. North, H. Taylor, et al. Increasing paternal age is associated with delayed conception in a large population of fertile couples: evidence for declining fecundity in older men. Human Reproduction, 15 (8), 2000: 1703—1708.
Rhoden EL, Morgentaler A. Risks of testosterone—replacement therapy and recommendations for monitoring. New England Journal of Medicine 350 (2004):482—92.
Malaspina D., etal Advancing Paternal Age and the Risk of Schizophrenia Arch Gen Psychiatry.158:758, 2001
Mathieu, C., Ecochard, R.,Bied, V.,Cummulative conception rate following intrauterine artificial insemination with husband's spermatozoa:influence of husband's age. Human Reproduction 1995,10,1090—1097
Tweeny-
IVF is Invitrofertilization and
ICSI is Intracytoplasmic sperm injection
We are having this done- My husband is 38.. and we have one child. We have encountered a slew if issues starting this year - we had a great count in Jan. '08 with 56 million and then 3 weeks later his count dropped drastically to at one point 142,000- we think it was an injury to his testicles..not sure- however things were on the up and up- he was making great improvements ( no meds) and then was stricken with Lyme Disease- we decided that to optimize our chances we would freeze his sperm and do ICSI- We have 2 vials on ice- one containing 9.8million sperm, the other 34 million sperm.
Basically ICSI is an acronym for intracytoplasmic sperm injection - which is a long, fancy way of saying "inject sperm into the middle of the egg". ICSI is a very effective method to get fertilization of eggs in the IVF lab after they have been retrieved from the female partner. IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and then pick up individual sperms in a tiny specially designed hollow ICSI needle. Then the needle is carefully advanced through the outer shell of the egg and egg membrane and the sperm is then injected into the inner part (cytoplasm) of the egg. This will usually result in normal fertilization in approximately 70-85% of eggs injected with viable sperm. First, the woman must be stimulated with medications and have an egg retrieval procedure so that we can obtain several eggs in order to attempt in vitro fertilization and ICSI.
There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not. Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes. Our thinking has changed over time - we are now doing more ICSI (as a percentage of total cases) than in the past. Certainly, as we learn more about ways that we can help couples conceive, our thinking in this area will continue to evolve. Having said that, we are currently recommending in vitro fertilization (IVF) with ICSI for:
1. All couples with severe male factor infertility that do not want donor sperm insemination.
2. All couples with infertility with:
Sperm concentrations of less than 15-20 million per milliliter
OR
Sperm motility less than 35%
OR
Very poor sperm morphology (subjective - specific cutoff value is not appropriate)
3. All couples having IVF who have had a previous cycle with no fertilization - or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
4. All couples having IVF who have a very low yield of eggs at the egg retrieval - our current cutoff is 5-6 (or less) eggs. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (just mixing eggs and sperm together).
How is ICSI performed?
1. The mature egg is held with a specialized holding pipette.
2. A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.
3. This needle is then carefully inserted through the zona (shell of egg) and in to the cytoplasm of the egg.
4. The sperm is injected in to the cytoplasm and the needle carefully removed.
5. The eggs are checked the next morning for evidence of normal fertilization.
Intracytoplasmic sperm injection - ICSI and IVF
Highly effective treatment for male factor infertility problems
Advanced Fertility Center of Chicago
Infertility and In Vitro Fertilization Specialist Clinic
Gurnee & Crystal Lake, Illinois
Our IVF Success Rates
Our IVF with Donor Eggs Success Rates
What is ICSI?
ICSI is an acronym for intracytoplasmic sperm injection - which is a long, fancy way of saying "inject sperm into the middle of the egg". ICSI is a very effective method to get fertilization of eggs in the IVF lab after they have been retrieved from the female partner. IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and then pick up individual sperms in a tiny specially designed hollow ICSI needle. Then the needle is carefully advanced through the outer shell of the egg and egg membrane and the sperm is then injected into the inner part (cytoplasm) of the egg. This will usually result in normal fertilization in approximately 70-85% of eggs injected with viable sperm. First, the woman must be stimulated with medications and have an egg retrieval procedure so that we can obtain several eggs in order to attempt in vitro fertilization and ICSI.
See a series of images demonstrating the ICSI technique
Who should be treated with intracytoplasmic sperm injection?
There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not. Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes. Our thinking has changed over time - we are now doing more ICSI (as a percentage of total cases) than in the past. Certainly, as we learn more about ways that we can help couples conceive, our thinking in this area will continue to evolve. Having said that, we are currently recommending in vitro fertilization (IVF) with ICSI for:
1. All couples with severe male factor infertility that do not want donor sperm insemination.
2. All couples with infertility with:
Sperm concentrations of less than 15-20 million per milliliter
OR
Sperm motility less than 35%
OR
Very poor sperm morphology (subjective - specific cutoff value is not appropriate)
3. All couples having IVF who have had a previous cycle with no fertilization - or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
4. All couples having IVF who have a very low yield of eggs at the egg retrieval - our current cutoff is 5-6 (or less) eggs. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (just mixing eggs and sperm together).
How is ICSI performed?
1. The mature egg is held with a specialized holding pipette.
2. A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.
3. This needle is then carefully inserted through the zona (shell of egg) and in to the cytoplasm of the egg.
4. The sperm is injected in to the cytoplasm and the needle carefully removed.
5. The eggs are checked the next morning for evidence of normal fertilization.
ICSI fertilization procedure in progress
Needle with a sperm inside is advanced to the left
Shell of embryo has already been penetrated by needle
Membrane of egg (oolemma) is stretching and is about to break
Sperm head visible at tip of needle
More ICSI images
Fertilization and pregnancy success rates with ICSI
Fertilization rates for ICSI: Most IVF programs see that about 70-85% of eggs injected using ICSI become fertilized. We call this the fertilization rate, which is different from the pregnancy rate.
Pregnancy success rates for in vitro fertilization procedures with ICSI have been shown in some studies to be higher than for IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quantity and quality) as compared to some of the women having IVF for reasons other than male factor infertility. Another way to say this is - average egg quantity and quality is usually better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs - as compared to cases with unexplained infertility in which there is more probability of a somewhat reduced egg quantity and quality (on the average, since some women in this group have egg related issues).
ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician performing the procedure.
Sometimes IVF with ICSI is done for "egg factor" cases - low ovarian reserve situations. This is when there is either a low number of eggs, or lower "quality" eggs (or often both). In such cases, ICSI fertilization and pregnancy success rates are somewhat lower (as a group) since the main determinant of IVF success is the quality of the transferred embryos - and the quality of the eggs is the most crucial factor determining the quality and viability of the resulting embryo.
In some cases, assisted hatching might be done on the embryos prior to transfer, in order to maximize chances for pregnancy.
Sorry so long :)
IVF is Invitrofertilization and
ICSI is Intracytoplasmic sperm injection
We are having this done- My husband is 38.. and we have one child. We have encountered a slew if issues starting this year - we had a great count in Jan. '08 with 56 million and then 3 weeks later his count dropped drastically to at one point 142,000- we think it was an injury to his testicles..not sure- however things were on the up and up- he was making great improvements ( no meds) and then was stricken with Lyme Disease- we decided that to optimize our chances we would freeze his sperm and do ICSI- We have 2 vials on ice- one containing 9.8million sperm, the other 34 million sperm.
Basically ICSI is an acronym for intracytoplasmic sperm injection - which is a long, fancy way of saying "inject sperm into the middle of the egg". ICSI is a very effective method to get fertilization of eggs in the IVF lab after they have been retrieved from the female partner. IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and then pick up individual sperms in a tiny specially designed hollow ICSI needle. Then the needle is carefully advanced through the outer shell of the egg and egg membrane and the sperm is then injected into the inner part (cytoplasm) of the egg. This will usually result in normal fertilization in approximately 70-85% of eggs injected with viable sperm. First, the woman must be stimulated with medications and have an egg retrieval procedure so that we can obtain several eggs in order to attempt in vitro fertilization and ICSI.
There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not. Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes. Our thinking has changed over time - we are now doing more ICSI (as a percentage of total cases) than in the past. Certainly, as we learn more about ways that we can help couples conceive, our thinking in this area will continue to evolve. Having said that, we are currently recommending in vitro fertilization (IVF) with ICSI for:
1. All couples with severe male factor infertility that do not want donor sperm insemination.
2. All couples with infertility with:
Sperm concentrations of less than 15-20 million per milliliter
OR
Sperm motility less than 35%
OR
Very poor sperm morphology (subjective - specific cutoff value is not appropriate)
3. All couples having IVF who have had a previous cycle with no fertilization - or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
4. All couples having IVF who have a very low yield of eggs at the egg retrieval - our current cutoff is 5-6 (or less) eggs. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (just mixing eggs and sperm together).
How is ICSI performed?
1. The mature egg is held with a specialized holding pipette.
2. A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.
3. This needle is then carefully inserted through the zona (shell of egg) and in to the cytoplasm of the egg.
4. The sperm is injected in to the cytoplasm and the needle carefully removed.
5. The eggs are checked the next morning for evidence of normal fertilization.
Intracytoplasmic sperm injection - ICSI and IVF
Highly effective treatment for male factor infertility problems
Advanced Fertility Center of Chicago
Infertility and In Vitro Fertilization Specialist Clinic
Gurnee & Crystal Lake, Illinois
Our IVF Success Rates
Our IVF with Donor Eggs Success Rates
What is ICSI?
ICSI is an acronym for intracytoplasmic sperm injection - which is a long, fancy way of saying "inject sperm into the middle of the egg". ICSI is a very effective method to get fertilization of eggs in the IVF lab after they have been retrieved from the female partner. IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and then pick up individual sperms in a tiny specially designed hollow ICSI needle. Then the needle is carefully advanced through the outer shell of the egg and egg membrane and the sperm is then injected into the inner part (cytoplasm) of the egg. This will usually result in normal fertilization in approximately 70-85% of eggs injected with viable sperm. First, the woman must be stimulated with medications and have an egg retrieval procedure so that we can obtain several eggs in order to attempt in vitro fertilization and ICSI.
See a series of images demonstrating the ICSI technique
Who should be treated with intracytoplasmic sperm injection?
There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not. Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes. Our thinking has changed over time - we are now doing more ICSI (as a percentage of total cases) than in the past. Certainly, as we learn more about ways that we can help couples conceive, our thinking in this area will continue to evolve. Having said that, we are currently recommending in vitro fertilization (IVF) with ICSI for:
1. All couples with severe male factor infertility that do not want donor sperm insemination.
2. All couples with infertility with:
Sperm concentrations of less than 15-20 million per milliliter
OR
Sperm motility less than 35%
OR
Very poor sperm morphology (subjective - specific cutoff value is not appropriate)
3. All couples having IVF who have had a previous cycle with no fertilization - or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
4. All couples having IVF who have a very low yield of eggs at the egg retrieval - our current cutoff is 5-6 (or less) eggs. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (just mixing eggs and sperm together).
How is ICSI performed?
1. The mature egg is held with a specialized holding pipette.
2. A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.
3. This needle is then carefully inserted through the zona (shell of egg) and in to the cytoplasm of the egg.
4. The sperm is injected in to the cytoplasm and the needle carefully removed.
5. The eggs are checked the next morning for evidence of normal fertilization.
ICSI fertilization procedure in progress
Needle with a sperm inside is advanced to the left
Shell of embryo has already been penetrated by needle
Membrane of egg (oolemma) is stretching and is about to break
Sperm head visible at tip of needle
More ICSI images
Fertilization and pregnancy success rates with ICSI
Fertilization rates for ICSI: Most IVF programs see that about 70-85% of eggs injected using ICSI become fertilized. We call this the fertilization rate, which is different from the pregnancy rate.
Pregnancy success rates for in vitro fertilization procedures with ICSI have been shown in some studies to be higher than for IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quantity and quality) as compared to some of the women having IVF for reasons other than male factor infertility. Another way to say this is - average egg quantity and quality is usually better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs - as compared to cases with unexplained infertility in which there is more probability of a somewhat reduced egg quantity and quality (on the average, since some women in this group have egg related issues).
ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician performing the procedure.
Sometimes IVF with ICSI is done for "egg factor" cases - low ovarian reserve situations. This is when there is either a low number of eggs, or lower "quality" eggs (or often both). In such cases, ICSI fertilization and pregnancy success rates are somewhat lower (as a group) since the main determinant of IVF success is the quality of the transferred embryos - and the quality of the eggs is the most crucial factor determining the quality and viability of the resulting embryo.
In some cases, assisted hatching might be done on the embryos prior to transfer, in order to maximize chances for pregnancy.
Sorry so long :)
June 26, 2007