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.

Could losing weight help you get pregnant?

120px-ZAYİFLAMA-İP-UCLARİIt is well-known that being very overweight can have an impact on your fertility, and so obese women are often told that they need to lose weight in order to have fertility treatment.

Now, new analysis of research from the Netherlands suggests that losing weight if you are obese might not have an immediate impact on your chances of getting pregnant with fertility treatment but what it does make a difference to is your chances of getting pregnant naturally.

The researchers found weight loss had a significant impact on the chances of getting pregnant naturally, particularly for women who were not ovulating. There was a marked increase in the chances of getting pregnant naturally for this group when they lost weight. The research team suggest that this shows that healthy lifestyle changes could be a first port of call for obese women, especially those who aren’t ovulating.

You can read more about this research presented at the European Society of Human Reproduction and Embryology annual meeting here.

Should I have an endometrial scratch?

800px-Woman-typing-on-laptopIf you are having IVF treatment, you’ve probably read online about endometrial scratch – a procedure which involves “injuring” the lining of the womb and which apparently can increase the chances of an embryo implanting.

The procedure has been in the news this week after a new review of the trials of endometrial scratch was released which suggests it may be beneficial for couples who are either trying to conceive naturally or using IUI where it seemed to increase the chances of success considerably.  This has been widely reported as suggesting that everyone should go off and have a scratch but it is important to note that the review concludes that  “the quality of the available evidence is low”.

You can read more about the review presented at the European Society of Human Reproduction and Embryology here. There are currently trials being carried out looking at the success of endometrial scratch which should give some more good quality evidence to show whether or not the procedure is worth paying for.