The editor-in-chief of one of the world's leading reproductive medicine journals has attacked the rising use of intracytoplasmic sperm injection (ICSI) for the treatment of infertility, following publication of the latest world report on assisted reproductive technologies (ART) [1] today (Saturday).
The report in Human Reproduction shows that while ICSI use has levelled off in some regions, its use is approaching 100% of assisted reproduction cycles in the Middle East and a few countries in other regions, despite the fact that ICSI was developed for the treatment of male infertility, which is a factor in around 40% of couples seeking fertility treatment [2]. The world report covers the years 2008, 2009 and 2010 -- the years for which the most recent data are available.
In an editorial entitled "Santa Claus in the fertility clinic" [3], to accompany the world report by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), Professor Hans Evers highlights the fact that in 2010 there were 220,000 in vitro fertilisation (IVF) treatments, but there were more than 455,000 ICSI treatments in the world. There was 1.4 times as much ICSI than IVF in Asia, twice as much in sub-Saharan Africa, just over twice as much in Europe, 2.7 times as much in North America, more than six times as much in Latin America and more than 60 times as much in the Middle East.
He writes that doctors are guilty of over-estimating the effect of ICSI. "The majority of the patients who will get pregnant with intracytoplasmic sperm injection (ICSI) will also do so with IVF." Studies have shown that ICSI results in fewer live births than IVF when used for couples where male infertility is not the problem. "Intending to improve their patients' pregnancy probability by preventing fertilization failure, well-meaning doctors actually decrease their chances. This has to stop. We have pledged to do no harm," he writes.
Prof Evers says doctors will serve their patients best by making decisions based on the evidence, "not by playing Santa Claus and doling out nicely wrapped presents of unnecessary, ineffective and costly care."
The authors of the ICMART report say that the reasons behind the high use of ICSI are not fully understood and are beyond the scope of their report. They write: "Investigating why ICSI is a preferred fertilization technique in a number of countries, particularly in Latin America and the Middle East, is warranted."
The report includes data from nearly 2,500 ART clinics from between 58 and 61 countries in the years 2008, 2009 and 2010, and it is the first time the report has included all regions of the world, with the first submissions of data from some sub-Saharan African countries.
During the three years, more than 4,461,300 ART cycles were carried out, resulting in an estimated 1,144,858 babies born around the world. This represents a 9.5% increase in the number of cycles over the three years and a 9.1 increase in babies born.
The report shows wide variation in the use of ART between countries. Globally, ART use remained fairly constant, with 436 cycles per million of the population in 2008 and 474 cycles per million in 2010. However, ART use ranged from 4,775 cycles per million in Israel (which had consistently the highest levels of access over the three years) to just eight cycles per million in the Dominican Republic in 2010. In the same year there were almost 2,500 cycles per million in Australia and New Zealand, more than 900 per million in Europe, 570 cycles per million in North America, 150 cycles per million in Latin America and nearly 90 cycles per million in sub-Saharan Africa. The authors of the report write that the global figure for the use of ART "conservatively represents less than 20% of the demand for ART treatment being met."
The safety of ART improved, with an increase in the number of single embryos transferred per cycle. This increased from 25.7% in 2008 to 30% in 2010, while the average number of embryos transferred fell from 2.1 to 1.9 and the rates of twin and triplet births also fell. However, there were wide regional variations: in Australia and New Zealand 8.2% of ART births were twins, but 30% were twins in the Middle East. The practice of freezing embryos and then thawing them and transferring them to women's wombs (known as frozen embryo transfer or FET) also increased by 27.6% between 2008 and 2010; FET cycles had approximately half the multiple birth rate when compared with fresh embryo transfers, namely 13% (2008), 11.9% (2009) and 12% (2010), with just 0.6% triplet births in all three years.
The first author of the ICMART report, Professor Silke Dyer, a senior specialist in reproductive medicine in the Department of Obstetrics and Gynaecology, at Groote Schuur Hospital and the University of Cape Town, South Africa, said: "The move towards single embryo transfer (SET) and thus towards greater safety and better outcome for ART is a significant finding. Very importantly, however, SET is not a stand-alone practice or finding, but closely related to the cost patients pay for treatment, and to utilisation rates and the use of FET. Supportive funding of ART, either through public or third party funding [4], increases utilisation through the provision of more affordable ART treatment, and at the same time encourages SET, which in turn allows for the freezing of excess embryos. This means patients and doctors are under less pressure to maximise the immediate chance of pregnancy by transferring more than one embryo, which comes with the risk of multiple pregnancy.
"We must acknowledge that this approach carries additional cost. However, given that the optimal outcome of fertility treatment is a healthy single live birth, supportive funding meets the dual goals of equitable access to treatment and safer outcomes for ART-conceived children and mothers. The global multiple birth rate of 21.5% in 2010 is still too high, and policy and practice should seek
to reduce the multiple birth rates.
"Through this three-year report, as well as our previous reports, we contribute to a global understanding of the role of scientific data, and how these data can and should inform sound policy-making."
[1] "International Committee for Monitoring Assisted Reproductive Technologies -- world report on assisted reproductive technologies: 2008-2009-2010"
[2] ICSI is a technique in which a single sperm is injected into the centre of a woman's egg. It is designed to be used in situations where there are very few good quality sperm available for conventional in vitro fertilisation (IVF) techniques.
[3] "Santa Claus in the fertility clinic," by J.L.H. (Hans) Evers. Human Reproduction journal. doi:10.1093/humrep/dew092.
[4] Third party funding covers funding by neither the supplier (hospital or unit through their internal funds) nor the patient; the third party could be a medical aid or insurance scheme, or a government fund or other funding models.
ICSI is a widely used treatment option. the best sperm is inserted straight to the egg which increases chances of successful fertilization. But to my mind a reputable repro center will not go straight to ICSI in the most of cases. Meaning they have also some other affective plans for their patients. Moreover, some say ICSI might cause damage to the embryo if performed unprofessionally. There's a dosage of realizm in this, 'cause dr will use a special needle to make the sperm pass directly into the egg..Anyway, this is yet another treatment option to count on.
ReplyDeleteI know that ICSI-IVF is recommended for couples who have had poor or no fertilisation during standard IVF, as well as men who have: Poor sperm morphology (abnormally shaped sperm). Poor sperm motility (slow moving). A low sperm count. An obstruction such as a vasectomy, which prevents sperm release. Antisperm antibodies (antibodies that are produced by the man’s body and may inhibit sperm function).
ReplyDeleteA vasectomy reversal that was unsuccessful or resulted in a low sperm count or poor-quality sperm.
As far as I know ICSI is considered to have higher chances of success. comparing to that of IVF. But there are also some minuses of the procedure. Let's say MIGHT be..If performed unprofessionally the injection may cause a serious damage to the egg. This will lead to the poor embie creation with some obvious or not deffects.
Anyway, the option is worth trying if one wants to boost her chances of conceiving through IVF.
I'd rather say, noone can guarantee you a baby first. God is the one who guarantees. This also comes to the question if the baby is going to be healthy or not. A good qualified clinic only helps us to get the best of the treatment. Me 30. DH 32
ReplyDeleteAfter 3 years in which we tried everything we were doing IVF in Greece with Iakentro Athens.
Short Protocol with Bemfola and Cetrotide
19mature eggs and we have 9 day5 blasto.
FET#1 ended in a very early loss,chemical pregnancy.
FET#2 ended in a loss at 22w due to IC,my boys will be forever in my heart .
FET#3 MMC at the 10 weeks ultrasound. Sometimes it takes time to understand you have to make changes. We weren't successful with Greek clinic, paid out of pocket for treatments with no luck. No proper investigation done, no accurate answers about the losses reasons..We felt we were robbed..With our brave faces on we switched it for another hope. I'm praying this time is our rainbow..
Fertilization can be attempted using two common methods:
ReplyDeleteInsemination. During insemination, healthy sperm and mature eggs are mixed and incubated overnight.
Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.
In certain situations, your doctor may recommend other procedures before embryo transfer.
Assisted hatching. About five to six days after fertilization, an embryo "hatches" from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you're an older woman, or if you have had multiple failed IVF attempts, your doctor might recommend assisted hatching — a technique in which a hole is made in the zona pellucida just before transfer to help the embryo hatch and implant.
Preimplantation genetic testing. Embryos are allowed to develop in the incubator until they reach a stage where a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, typically after five to six days of development. Embryos that don't contain affected genes or chromosomes can be transferred to your uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it can't eliminate the risk. Prenatal testing may still be recommended.
I really don't care what options are used if only those were effective to couples. Of course it's thremendous how high the number of infertile couples there is nowadays. But there is nothing to be done about that unfortunately. Due to some reasons people find out one day they cannot conceive or carry pregnancy themselves. Or that they were born without some of the reproductive organs. We should be thankful for all the options we can apply nowadays to fulfill our families. We've been successfully through ivf treatment with donor egg at Biotexcom. Currently I'm 9,6 weeks prego with a little one. Furthermore we're planning to go for another DE ivf round some time later..
ReplyDeleteThank you for sharing this info. ICSI is great as any other procedure to my opinion. And if this very procedure helps experts to achieve patients' pregnancy I can only wish good luck. ICSI does not mean a definite live baby in the end. But it does offer a better chance than not using it. Depending on a situation of course. For example, I get pregnant very easily naturally. But I'm a habitual aborter. So ICSI in my case is to ensure that a healthy sperm meets a healthy egg and gives me less of a chance to miscarry. In some other examples, it's just to get the sperm and egg to meet. Men with a low sperm count may have sperm that dies too quickly before meeting the egg. So ICSI gives the good sperms he has the chance to fertilize. There are many reason to use ICSI. There's risk with everything. People worry that piercing the egg will cause it to die. I'm no scientist, but so far, that doesn't appear to be the case if the egg is healthy to begin with. That's really only my opinion.
ReplyDeleteI'm going to talk about complications of infertility treatment in this post. All the information was kindly provided by our Dr at Biotexcom repro center. Those may include:
ReplyDeleteMultiple pregnancy. The most common complication of infertility treatment is a multiple pregnancy - twins, triplets or more. Generally, the greater the number of fetuses, the higher the risk of premature labor and delivery. As well as problems during pregnancy such as gestational diabetes. Babies born prematurely are at increased risk of health and developmental problems.
Ovarian hyperstimulation syndrome. Fertility medications to induce ovulation can cause OHSS, in which the ovaries become swollen and painful. Symptoms may include mild abdominal pain, bloating and nausea that lasts about a week, or longer if you become pregnant. Rarely, a more severe form causes rapid weight gain and shortness of breath requiring emergency treatment.
Bleeding or infection. As with any invasive procedure, there is a rare risk of bleeding or infection with assisted reproductive technology. So be attentive to yourself. Take a good care. Hope this message is useful.
To get ready for the first appointment it's better to do the following beforehand (At least I did so when we were getting ready for the 1st app at BTC some time ago). Provide details about your attempts to get pregnant. Write down details about when you started trying to conceive and how often you've had intercourse. Especially around the time of ovulation. Bring your key medical information. Include any other medical conditions you or your partner has. As well as information about any previous infertility evaluations or treatments. Make a list of any medications, vitamins, herbs or other supplements you take. Include the doses and how often you take them. Make a list of questions to ask your doctor. One should remember: the better you start - the higher chances you'll have.
ReplyDelete