Do you really need ICSI?

ICSI (intracytoplasmic sperm injection) is a successful treatment when there are male fertility problems, but it is often used more widely in fertility clinics – and some offer ICSI to many patients where there is no male factor problem at all. Now, new research presented at ESHRE (the European Society of Human Reproduction and Embryology) shows that there is no benefit to offering ICSI unless there is a male fertility issue.

ICSI was developed in the 1990s as a breakthrough treatment for men who would otherwise have had to use donor sperm to become a parent, but now it is used so often that twice as many ICSI cycles are carried out around the world as IVF cycles. In some countries all assisted conception cycles are ICSI.

This large study of almost 5000 patients in Belgium and Spain being treated with ICSI or IVF found there was no benefit to using ICSI where there was no male fertility problem. The results of the study were presented by Dr Panagiotis Drakapoulos from UZ Brussels, the Belgian centre where ICSI was developed more than 25 years ago. The study was a collaboration between the Brussels centre and 14 clinics in Spain.

The reason given for using ICSI is often that it is thought it results in a higher chance of fertilisation and more embryos, but this large study showed no overall difference in outcome using IVF or ICSI regardless of whether the female patients had large numbers of eggs (more than 15) or not so many (1-3) – so there is no rationale for using it to try to improve outcomes in cycles where there are just a few eggs.

The use of ICSI varies around the world, with the highest rates in many countries of Eastern and Mediterranean Europe. There is a slightly lower use in some Nordic countries, the UK and France. In its latest review of treatment trends in the UK, the HFEA reported that ICSI use ‘continued to increase until 2014, but it is now in decline, possibly due to clinical opinion that it’s not needed in all contexts of IVF’. 

This reflects the message from this study, which, according to Dr Drakapoulos, found ‘no justification for the use of ICSI in non-male factor infertility’. He added that the number of eggs retrieved ‘should not play any role in selecting the insemination method’. Dr Drakapoulos also highlighted the extra financial cost of ICSI over IVF.

Men have a biological clock too

We’re all very aware of the female biological clock, but what we don’t hear so so much about is the fact that male sperm counts decline and DNA damage in sperm cells may increase as men get over. The fact that some high-profile men have become fathers when they are pensioners perpetuates the myth that male fertility lasts forever.

In fact, evidence shows men do have a biological clock with a decline in natural male fertility and an increase in the miscarriage rate as men get older. New evidence at ESHRE from one London fertility clinic shows that IVF/ICSI is less likely to succeed if a male partner is over 51 too.

Dr Guy Morris from the Centre for Reproductive and Genetic Health (CRGH) in London presented results at the ESHRE (European Society of Human Reproduction and Embryology) conference of an analysis of more than 5000 IVF/ICSI cycles which found that although there was no difference in miscarriage rates, there was a significant reduction in the chances of success

The results showed that that clinical pregnancy rate declined as men got older – from 49.9% when men were under 35, to 42.5% for men aged 36-40, 35.2% for those aged 41-45, 32.8% for those aged 46-50, and 30.5% in the over 51s.

The researchers also noted that 80% of couples where the male partners were over 51 were treated with ICSI, a treatment developed for male infertility. Dr Morris said: ‘There may well be a public perception that male fertility is independent of age. Stories of celebrity men fathering children into their 60s may give a skewed perspective on the potential risks of delaying fatherhood. Indeed, in natural conception and pregnancy it is only recently that evidence of risks associated with later fatherhood has become available. These more recent studies contrast with decades of evidence of the impact that maternal age has on fertility outcomes. In the context of this emerging evidence for the deleterious effect of increasing paternal age, our data certainly support the importance of educating men about their fertility and the risks of delaying fatherhood.’ 

Low cost IVF

One of the subjects discussed at the ESHRE fertility conference in London this week was low cost IVF with much made in the papers this morning of the fact that this “no frills” IVF could cost as little as £200, £180 or £170 (depending on which newspaper you happened to be reading). According to the research team, this simplified version of IVF was still capable of producing excellent success rates and could be used to offer IVF in developing countries where people could not afford the thousands of pounds for conventional treatment – and eventually in the rest of the world too.

This was hailed as an amazing new development, but in fact, low cost IVF is not a new idea.  There’s an organisation called The Low Cost IVF Foundation which was set up in 2007 and has been campaigning on this issue for some years.  Headlines from as far back as 2008 were highlighting the possibility of an IVF cycle for less than 200 dollars, but one of the problems with any fertility treatment is that those involved nowadays expect to make healthy profits – or at least take very healthy salaries.

It is five years since we first heard that IVF could be carried out for less than 200 dollars, but we have yet to see this taking off across the world.  It will be interesting to see where we are in another five years and how things progress with the advances discussed at ESHRE this week.

 

Could you help??

Could you give up a few hours of your time in London on Monday July 8 to help raise funds for fertility support

Every year ESHRE, the European Society of Human Reproduction and Embryology, holds an annual conference which is a leading event for fertility specialists from around Europe. This year it is being held in London, and they need a small team of volunteers to help out as marshalls on the route for the charity fun run that they do each year. The funds raised will go to Fertility Europe, the patient organisation which works to get equal access to fertility care throughout Europe.

The run will take place on MONDAY 8 JULY and marshalls would be needed from 5.30 pm at ExCel Convention Centre in London. It involves being at the start/finish of the run, helping to direct the runners along the course and helping out at a water station. If this is something you might be able to consider helping with, please email Hannah  hannahtramaseur@infertilitynetworkuk.com or Kate katebrian@infertilitynetworkuk.com