Sunday, July 20, 2008

ICSI: Good? Bad? WTF??

A NY Times article today suggests that ICSI can lead to birth defects, learning disabilities and sterility in boys. She does not cite any medical journals but says there could be problems.

I searched my academic databases to find a meta-analysis that argues ICSI does not cause more birth defects, a meta analysis that argues that IVF and ICSI have more birth defects than spontaneous conception, and a large study that shows no differences in birth defects for ICSI over IVF.

I trust large studies and meta analyses over single articles because these sorts of studies are able to account for odd blibs in procedures and studies that can cause errors in any one study. I also do not always trust the media because they like to exploit fears in their readers, and this is most definitely a possibility. I've emailed the author, Peggy Orenstein, to ask her to provide her reference for that suggestion and am waiting to hear back.

I know one of her main points is that IVF/DE/ART procedures are a market not a science. Nonetheless, I don't know whether to request that we don't use ICSI because of a potentially incorrect belief in a nominal increase in birth defects at the risk of decreasing our chances of success at having a baby come home with us from the hospital.

Final point: these are traditional IVF and ICSI, not DE IVF or ICSI. People using traditional IVF/ICSI have fertility problems to begin with (egg and/or sperm quality) that DE can take completely out of the equation. I have to keep reminding myself that DE IVF compared to traditional IVF is simply not a fair comparison.

I think I've talked myself back into using ICSI in our cycle.


stacyb said...

with DE it's a totally new ball game...or egg game as the case may be (sorry). we kept telling ourselves that too, and it's actually true!

Anonymous said...

I guess it depends on the hubby's swimmers. If they're Olympian athletes, it may not be necessary. Ours were not, so we opted for ICSI, as recommended by the clinic.

Kami said...

I looked into this a lot a couple of years ago and found one descent sized study that found ICSI babies were slightly behind their IVF peers for a couple of years and then it evened out. We had MFI so we didn't have a choice. We have the same issues with DE obviously.

My embryologist thought that ICSI was a cleaner process although we did plain IVF when we tried DS. He said in nature the egg is constantly moving down the tube in a varying environment. In the dish, it is soaking in a single environment overnight. With ICSI, he enzymatically removes the granulosa cells so he can see inside the egg, injects the sperm and their done.

Personally, with DE and good sperm, I would skip ICSI. Maybe those granulosa cells do something.