Comparison of IVF versus ICSI for treatment of infertility

What does infertile mean?

In general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of attempting.

Women who can get pregnant but are unable to stay pregnant may also be infertile.

What can cause infertility in a woman?

There are many possible causes of infertility in women ranges from multiple factors to unexplained infertility.

Some possible causes of female infertility can include:

• Problems with the uterus: This includes polyps, fibroids, septum, or adhesions inside the cavity of the uterus.
• Problems with the fallopian tubes: The most common cause of “tubal factor” infertility is a pelvic inflammatory disease, usually caused by chlamydia and gonorrhea.
• Problems with ovulation: There are many reasons why a woman may not ovulate (release an egg) regularly. Hormonal imbalances, a past eating disorder, substance abuse, thyroid conditions, severe stress, and pituitary tumors are all examples of things that can affect ovulation.
• Problems with egg number and quality.

What causes male infertility?

Problems with male fertility can be caused by several health issues and medical treatments:

• Varicocele: A varicocele is a swelling of the veins that drain the testicle. It's the most common reversible cause of male infertility.
• Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm.
• Ejaculation issues: Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
• Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
• Tumors: Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
• Undescended testicles: In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
• Hormone imbalances: Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
• Defects of tubules that transport sperm: Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.
• Chromosome defects: Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis and Kallmann's syndrome.
  
  
• Problems with sexual intercourse: These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems.
• Celiac disease: Celiac disease is a digestive disorder caused by sensitivity to a protein found in wheat called gluten. The condition may contribute to male infertility. Fertility may improve after adopting a gluten-free diet.
• Certain medications: Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some ulcer drugs, some arthritis drugs and certain other medications can impair sperm production and decrease male fertility.
• Prior surgeries: Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.

Intracytoplasmic Sperm Injection (ICSI)

The introduction of intracytoplasmic sperm injection (ICSI) has been revolutionary breakthrough for parents who are facing difficulty in conceiving.

What is ICSI?

It is an in Virto Fertilization procedure in which a single sperm cell is injected directly into cytoplasm of an egg.

What's ICSI treatment in details?

As with regular IVF, the woman will first need to take fertility medication to stimulate the production of eggs in the ovaries. During this time, the doctor will monitor the development of the eggs.

The ICSI procedure starts when the egg is ready to be retrieved.

Step 1: Retrieval

The man will have to produce a sperm sample ejaculating into a cup or the sperm will have to be surgically retrieved.

Step 2: Injection of Sperm into Egg

Once retrieved the semen sample is washed and a single sperm is isolated. This is then injected into an egg with a very fine hollow needle. Since the sperm is injected directly, it bypasses the need to swim through the cervical fluid. It can take a sperm up to 24 hours to fertilize an egg and create an embryo.

Step 3: Monitoring the Embryo

The fertilized embryos are kept in a lab for up to 6 days. During this time, they are monitored for signs of growth and development. Not all the fertilized embryos will be transferred to the woman’s uterus. Hence this step is essential to pick out the healthiest and most viable embryos.

Step 4: Transfer of Embryos

Once the embryo has reached a certain stage of development, one or two embryos are selected and transferred to the woman’s womb using an ultrasound-guided catheter. This may happen 2 days after fertilization or 5 days after fertilization.

ICSI recommendations

At ILAJAK Medical we recommend ICSI if:

• You have a very low sperm count.
• Your sperm are abnormally shaped (poor morphology)
• Your sperms don't move normally (poor motility)
• You've had IVF previously and none, or very few of the eggs fertilized.

Abstinence before ICSI

We recommend abstaining for at least two days prior to the ICSI procedure but not more than 6 days. This will help to obtain optimal sperm quality for the ICSI procedure.

ICSI success symptoms

There are few positive signs which indicate the success of ICSI and means the embryo transfer was successful.

After ICSI pregnancy symptom

1. Bleeding or spotting

Light bleeding or spotting is often the first sign of pregnancy.

2. Cramping

Cramping is one of the first signs that “Aunt Flow” is on the way. It may also be a sign that an embryo transfer was successful.

3. Sore breasts

One early sign of pregnancy, for some people, is sore breasts.

4. Tiredness or fatigue

Feeling tired and fatigued seems to be a typical part of pregnancy from day 1 to delivery. But you may feel extra sleepy early on when your progesterone levels soar.

5. Nausea

Nausea or morning sickness typically starts in the second month of pregnancy, so it’s not necessarily a symptom you would notice in the 2 weeks following an embryo transfer.

6. Bloating

You can blame an increase in progesterone levels for the extra bloat around your belly. When this hormone surges, as it does when you’re pregnant or taking fertility drugs, it can slow down your digestive tract and cause you to feel more bloated than usual.

7. Changes in discharge

If your doctor prescribes progesterone in a vaginal preparation (suppositories, gel, or vaginal tablets) to use during the 2-week wait, you may notice changes in vaginal discharge that have nothing to do with a positive pregnancy test.

8. Increased need to pee

Late-night trips to the bathroom and an increased need to make more pit stops could be a sign of early pregnancy.

9. Missed period

A missed period can signal pregnancy, especially if your cycle runs like clockwork.

10. No symptoms

If, after reading this list, you realize that none of these apply, don’t worry. Just because you’re not experiencing specific symptoms, doesn’t mean the embryo transfer wasn’t successful.

The listed symptoms, are most commonly the result of estrogen and progesterone administration.

The only for-sure way to know if your embryo transfer worked is a positive pregnancy test.

How long after ICSI does fertilization occur?

Fertilization is assessed 16 - 18 hours after insemination or ICSI.

The fertilized eggs are called zygotes and are cultured in a specially formulated culture medium that supports their growth. They will be assessed on the second and third day after retrieval.

ICSI success rate

ICSI usually fertilizes 50-80% of the eggs it is performed on.

ICSI failure reasons

The most common cause for ICSI failure is using round-head sperm due to inability of sperm to activate the oocyte. In some forms of globozoospermia, arrest of nuclear decondensation and/or premature chromosome condensation also causes fertilization failure.,

• ICSI implantation failure symptoms

If the positive signs of successful ICSI do not have any existence even after a couple of weeks, post-ICSI, it might be an indicative of a failure.

• What to do after ICSI failure?

A failed ICSI can be devastating for you and your partner. You may feel lost, at loose ends, and profoundly depressed. But, you aren’t quite ready to give up your dream of growing your family.

If no fertilization happens after ICSI, we always look for the suitable substitution. We do artificially induced calcium rises, and in the majority of the patients, it works. It's only in less than 10% of the oocytes that we still don't have fertilization yet.

ICSI cost in Turkey

At ILAJAK Medical we commit to the highest level of medical services and patient satisfaction is our top priority, Costs for ICSI starts from 4,000 USD.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab.

What does IVF stand for?

IVF stands for In Vitro Fertilization.

Why do people choose IVF?

Both IVF and ICSI increase the chances of fertilization regardless of whether infertility is an issue or not. Many couples choose in vitro fertilization because it helps them conceive more quickly at a time that's right for them. It increases chances of a healthy pregnancy and child.

IVF treatment procedure in detail?

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

Symptoms after IVF 3-day transfer

After embryo transfer is completed, it takes about nine days before a pregnancy can be detected. During the days after a transfer, the following happens to the embryo:

Day 1: The blastocyst begins to hatch out of its shell.

Day 2: The blastocyst continues to hatch out of its shell and begins to attach itself to the uterus.

Day 3: The blastocyst attaches deeper into the uterine lining, beginning implantation.

IVF success symptoms

IVF success shares the same symptoms with ICSI and natural pregnancy which we disclosed earlier and we will be shedding some lights on them trimester wise.

IVF pregnancy symptoms

The First Trimester:

The first trimester refers to the first three months of gestation, from week 0 to 12

For an IVF patient, in practical terms, this can mean that you may be dealing with a higher level of anxiety and a greater sensitivity to early pregnancy symptoms than many women experience at this stage.

Symptoms may include:

• The uterus, grows. It can be felt rising in the pelvis.
• The pregnant woman gradually gains weight. Her heart works faster to support the growing fetus.
• Morning sickness is the worst part of the first trimester. It happens due to hormonal changes and is experienced by most women. Generally, the problem is resolved by the end of the first trimester though some women may experience it later too.

The Second Trimester:

The second trimester is between 13 weeks and 24 weeks of gestation implants in the uterus.

Symptoms may include:

• 2 The expectant mother rapidly gains weight during the second trimester, at the rate of 0.5 kg per week.
• You may be feeling tired, bloated, nauseated, and moody without any assurance that you are actually pregnant.
• Changes in the breasts (such as heaviness and soreness) are a common experience in many early pregnancies.

The Third Trimester:

The third trimester is crucial, whether the pregnancy is natural or conceived with ILAJAK Medical in Istanbul.

Week 25 to 40 signifies the third trimester of the pregnancy

Symptoms may include:

• The woman’s breasts grow in size and start secreting colostrum.
• It becomes difficult for a woman to move around and even find a comfortable sleeping position. Indigestion, insomnia, acidity, and fatigue are experienced by the woman.
• The fetal movements become well-defined though the space is cramped now. As the third trimester approaches its end, the baby’s head drops in the pelvis, just on the top of the cervix.

Continue taking care of your own health and wellbeing, and enjoy all the planning and preparation for parenthood that is such a special part of pregnancy.

IVF success rate

Between the years 2014 and 2016 the percentage of IVF treatments that resulted in a live birth was:

• 29% for women under 35.
• 23% for women aged 35 to 37.

IVF failure reasons

Here we break the taboo and cover some of the reasons why IVF might fail.

1. Female Age:

As women grow older, their eggs decrease in quality and quantity

2. Embryo Quality:

Embryos can appear healthy in the lab, but when implanted into the uterus there is a possibility that they fail to implant due to an invisible defect.

3. Ovarian Response

In the beginning of IVF treatment, the female is required to administer a daily injection of a fertility hormone called follicle stimulating hormone (FSH), which aims to increase egg production. Some women’s ovaries do not respond correctly to this medication and thus fail to produce multiple eggs for collection.

4. Implantation Issues

This means that the embryos failed to implant in the uterus.

5. Chromosomal Abnormalities

IVF can fail due to embryos that have chromosomal abnormalities. This means that the embryo has a missing, extra, or irregular portion of chromosomal DNA

IVF failure symptoms

Vaginal bleeding may also be a sign of an ectopic pregnancy. This occurs when a fertilized egg implants into one of the fallopian tubes rather than that of the lining of the uterus. Some other symptoms may include pain in the abdomen, pelvis, or even the shoulder.

IVF cost in Turkey

At ILAJAK Medical we commit to the highest level of medical services and patient satisfaction is our top priority, Costs for IVF starts from 3750 USD.

ICSI vs IVF

In this segment we discuss the difference between ICSI and IVF and which one is better.

ICSI vs IVF which is better?

In IVF, fertilization and implantation rates were significantly higher than ICSI group (66.22% and 16.67% in IVF group versus 57.46% and 11.17% in ICSI, respectively).

Chemical and clinical pregnancy rates were statistically higher in IVF group as compared with the ICSI group (42.9% vs. 27.3% and 35.7% vs. 21.5%, respectively).

ICSI vs IVF difference

The key difference between IVF and ICSI is how the sperm fertilizes the egg.

In IVF, the egg and sperm (of which there are many) are left in a laboratory dish to fertilize on their own.

In ICSI, the selected sperm is directly injected into the egg.

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Sources: Cleveland Clinic +  NCBI + Fertility-Academy