Advanced Fertility care blog

Fertility Treatments

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Getting Pregnant With Clomid

Fertility Treatments

Getting Pregnant With Clomid

Infertility can stem from any number of causes, including things like endometriosis, ovulation problems, sperm-related issues, or polycystic ovarian syndrome (PCOS). Luckily, there are many treatment paths available for your unique fertility journey.  

Clomid, or clomiphene citrate, is an oral medication often used to treat infertility. Let's look closer at Clomid, the treatment process, and whether it's right for you.

doctor consulting with a couple about clomid

Understanding Clomid

Clomid stimulates ovulation by promoting follicle-stimulating hormone (FSH) secretion. FSH then stimulates the growth of egg follicles, which are fluid sacs in your ovaries with eggs in them. Assuming you naturally ovulate (which isn't always the case), you only ovulate one egg. The purpose of the Clomid is to get more than one follicle to grow. The whole goal of being on Clomid is to get 2-3 eggs to be released that month instead of just the one that is ordinarily ovulated. If you don't ovulate at all, clomid can help make you ovulate, which gives you a chance of getting pregnant that month. Clomid also leads to increased estrogen levels, which increases luteinizing hormone (LH) levels, stimulating egg release (ovulation). Clomid may also be given for a Clomid challenge test, which can diagnose age-related infertility, though this is not done as often as it was in the past.

Clomid is typically used in an intrauterine insemination (IUI) cycle but is also sometimes part of an in vitro fertilization (IVF) cycle. There's some evidence that Clomid may also promote sperm and testosterone production, so it could be used to treat male infertility in some cases. Clomid success rates vary from person to person, depending on the root cause of infertility.

The Process and Protocol

Seeing a fertility specialist can help you get to the bottom of what's causing your infertility. They'll discuss your medical history and perform any diagnostic testing that may be needed so they can devise a custom treatment plan.

A Clomid treatment plan may vary, depending on whether your menstrual cycles are regular or not. But typically, Clomid is taken for several days in a row, starting during your menstrual cycle. You may need to do several rounds of Clomid. However, if you still aren't getting pregnant after several cycles of taking Clomid, you may need to pursue additional treatment.

While you're taking Clomid, your fertility specialist may conduct ultrasounds to check on your follicle growth and development. They may also do blood tests to check your hormone levels to show whether the Clomid works. The tests also help determine the best time to have intercourse or undergo IUI. Ovulation usually happens around two weeks before your next menstrual cycle, so this may be when intercourse or IUI is recommended.

Potential Side Effects and Risks

woman reading her clomid pill bottle

Like any medication, Clomid can cause side effects. You may experience mood swings, hot flashes, discomfort around your ovaries, breast tenderness, headaches, or spotting. There's also an increased risk of multiple births with Clomid.

Ovarian hyperstimulation syndrome (OHSS) is another possible risk of taking Clomid, though this is actually quite rare when taking it orally. OHSS is when the ovaries become overstimulated from fertility medications, and they become swollen and painful. And you may experience symptoms like abdominal pain, nausea, and vomiting with OHSS. This condition, again, is rare with Clomid and usually lasts for less than a week.

Maximizing Success with Clomid

Clomid can help stimulate ovulation and increase the chances of pregnancy. Lifestyle changes, like eating a healthy diet and exercising, can help boost fertility. Avoiding smoking, minimizing alcohol use, and getting plenty of antioxidants and vitamin D can also be helpful for male infertility.

Whatever your situation, seeing a fertility specialist is essential to ensure you have the best possible chances of getting pregnant.

There is Hope for Those Dealing with Infertility

Clomid is one of many effective treatments for infertility. If you're struggling to get pregnant, don't hesitate to reach out to our professional, compassionate team of fertility specialists at Advanced Fertility Care. Contact us today with any questions or to schedule a consultation.

Read More
What does PGT test for?

Fertility Treatments

What does PGT test for?

Couples struggling with infertility may benefit from preimplantation genetic testing (PGT), which can increase the chances of having a successful pregnancy. Infertility clinics will perform PGT testing before implanting an embryo into the uterus for IVF. This article outlines what PGT is, discusses who could benefit from it, and explains the different types of PGT.

What is PGT? 

Preimplantation genetic testing (PGT) is an option for couples undergoing in vitro fertilization (IVF). This testing screens the embryos for potential genetic and chromosomal abnormalities before implanting them into the uterus. PGT plays a crucial role in selecting the embryos with the highest chance of success during fertility treatments, like IVF, for implantation. Only the unaffected embryos are transferred to the uterus for implantation to increase the success of implantation.

Is PGT for Me? Who Can It Help? 

There are many factors to consider when deciding to have PGT. Reasons to consider PGT include:

  • Previous pregnancy with aneuploidy (chromosome abnormality)
  • Two or more miscarriages
  • Couples at risk of having a child affected with an inherited genetic disorder
  • Previously failed embryo implantation
  • Women who are diagnosed with unexplained infertility
  • Women over the age of 35
  • Numerous unsuccessful fertility treatments

It is best to consult with a fertility specialist to make the best-informed decision. A fertility specialist will go over your health history, individual fertility journey and will be able to answer any questions.

Understanding the Different Types of PGT 

couple talking about pgt options with doctor

There are three different types of PGT. Preimplantation genetic testing-monogenic (PGT-M) testing targets a single gene disorder. Preimplantation genetic-testing aneuploid (PGT-A) is a broader test that screens for one or more extra or missing chromosomes, known as aneuploidy. Fertility clinics may recommend preimplantation genetic testing-structural rearrangements (PGT-SR) for concerns of translocations. Translocations are when two chromosomes break off and switch places.

Fertility specialists recommend conducting PGT during the blastocyst phase of an embryo, which is an early developmental stage of an embryo. Embryologists can also complete this testing at the embryo's later stages if needed. When performing PGT, embryologists will biopsy about 5-10 cells from the trophectoderm layer or the outer layer of an embryo that turns into the placenta. These cells do not require a biopsy of the inner cell mass, which turns into the developing fetus.

PGT-A (Aneuploidy Screening)

The PGT-A screens embryos for whole chromosome abnormalities. An embryo should have 46 chromosomes, of which half come from the egg and the other half from the sperm. PGT-A screens for any missing or extra chromosomes that may lead to failure of the embryo to implant, a miscarriage, or cause significant health issues for the child after birth. This screening counts the 46 chromosomes in an embryo to determine if there are any extra or missing chromosomes, a condition clinically referred to as aneuploidy. PGT-A screening can reduce the risk of having a child with genetic or chromosome abnormality, like Down syndrome, by identifying abnormal embryos so that transfer to a uterus can be avoided It can also help identify embryos with the greatest chance to implant during IVF, resulting in pregnancy.

Because PGT-A can identify embryos with high probability of implantation some fertility specialists recommended transferring only one embryo to avoid complications that may arise in pregnant patients with multiple fetuses.

Screening all 46 chromosomes means that the embryo sex is also available. This can benefit situations where a genetic disease is inherited based on embryo sex. Chromosomal abnormality in a developing fetus can lead to an increased risk of stillbirth, shortened lifespan, or cause significant medical problems after the child is born and is the leading cause of pregnancy loss. Screening the embryos for chromosomal abnormalities can avoid some of these situations and decreases the risk of miscarriage.

Additional testing of PGT-A adds extra cost to IVF. Insurance may not help cover the cost of PGT-A testing with the fertility treatment. Genetic screening tests also require embryologists to remove 5-10 cells from the trophectoderm, which are the cells that become the placenta. Testing is usually performed during the blastocyst stage of an embryo to decrease the risk of damage. The inner cells of the embryo that develop into the fetus are not disturbed. The risk of damage to the embryo is very low when performed in labs that routinely perform PGT screening.

Testing can deliver a false negative or false positive result. Healthy embryos can remain unused or for an embryo transfer with chromosomal abnormalities to occur due to test results. The test uses cells from the placenta and not the fetus, so it is not considered a diagnostic test. However, early genetic screenings also test cells from the placenta. Testing on the DNA of the fetus is not available until 15 weeks of pregnancy through an amniocentesis.

PGT-M (Monogenetic/single gene disorders)

PGT-M tests for a specific genetic mutation associated with a known diagnosis or known predisposition within the family. PGT-M does not test for all single gene disorders at once and will not detect genetic alterations present for the first time in one family member due to a variant. This type of testing uses cytogenetic or molecular techniques for single-gene disorders, like Huntington's disease, cystic fibrosis, or Fragile X syndrome. This includes single-gene disorders that are autosomal dominant and recessive or X-linked. PGT-M testing can also test for hereditary cancer syndromes like breast and ovarian cancer and Lynch syndrome. Furthermore, PGT-M can assist in detecting embryos that are compatible with human leukocyte antigens. These embryos can then be gestated so that ill family members can receive bone marrow transplants or cord blood transfusions compatible with their immune systems.

PGT-M tests a few cells from the early embryo, usually in the blastocyst stage. Misdiagnosis is possible but rare. To confirm the results of PGT-M, fertility specialists may recommend chorionic villus sampling (CVS) or amniocentesis.

PGT-SR (Structural Rearrangements)

happy couple holding healthy newborn after IVF with pgt

Embryos at risk for chromosome rearrangement, when pieces of chromosomes are missing, duplicated, or rearranged, may consider having PGT-SR testing. It is important to consider genetic counseling and preimplantation genetic screening with the discovery of structural rearrangement in either parent. An individual with a chromosomal rearrangement is at an increased risk of experiencing recurrent pregnancy loss or having a child with a chromosomal rearrangement. If someone has experienced two or more pregnancy losses, fertility specialists may recommend a karyotype screening to check for any possible chromosomal rearrangement before beginning IVF. Testing for PGT-SR can lower the chances of experiencing another pregnancy loss or giving birth to a baby with a chromosomal abnormality.

It's important to note that PGT-SR testing has certain limitations. For instance, this type of testing cannot distinguish between an embryo with a typical karyotype and one with a balanced form of familial chromosome rearrangement. Individuals who carry balanced chromosome rearrangement involving imprinted genes are susceptible to irregularities related to uniparental disomy. This occurs when the embryo receives both copies of a chromosome from one parent instead of inheriting one from each parent. Uniparental disomy cannot be excluded from all preimplantation genetic testing analysis methods. A fertility specialist may recommend CVS or amniocentesis to confirm PGT-SR results.

Helping With Your Fertility Journey

Preimplantation genetic testing can help increase the chances of successful implantation for IVF patients. There are various reasons it may be considered. If you have been struggling with infertility, discuss your situation with one of our fertility specialists at Advanced Fertility Care to determine if PGT is right for you.

Read More
Letrozole for Fertility

Infertility Resources & Support

Fertility Treatments

Letrozole for Fertility

Infertility is a common problem for many people trying to get pregnant. Fortunately, many treatment options are available to help those struggling with infertility. Medications, such as letrozole, are often recommended as part of an infertility treatment plan. 

What is Letrozole?

Letrozole is an oral medication that influences reproductive hormone balance in the body. Letrozole is an aromatase inhibitor, which reduces the hormone estrogen. It's widely used in breast cancer treatment, but it's also an effective treatment for infertility since its hormonal effects stimulate ovulation. 

How Safe is Letrozole, and Does It Work? 

couple discussing letrozole and fertility with reproductive doctor

Letrozole has been used to treat infertility for over twenty years. Success rates will always vary from person to person. Still, many studies suggest that letrozole is especially helpful for women dealing with polycystic ovarian syndrome (PCOS) or ovulation problems, like anovulation. 

Luckily, letrozole is safe to take, but like any medication, it can have side effects. Some women may experience hot flashes, night sweats, headaches, tiredness, breast tenderness, dizziness, and spotting, to name a few. Letrozole's side effects are mainly related to how it affects estrogen levels.  

Medication Alternatives to Letrozole

Medications are often the first-line treatment for women going through ovulation problems. Fertility drugs like letrozole impact hormones that affect ovulation and reproduction. 

Clomiphene is one common alternative to letrozole. This oral drug works on the pituitary gland, promoting the release of hormones that encourage the growth of ovarian follicles containing eggs. Clomiphene may be more effective for women who don't have PCOS. 

Human chorionic gonadotropin (hCG) is an injectable medication that may also help the body develop multiple ovarian follicles during an in vitro fertilization (IVF) cycle. 

Letrozole and IVF

woman pregnant with ultrasound after letrozole IVF

Letrozole can be a valuable part of IVF and IUI treatments since stimulating ovulation can help increase the chances of conception. 

Letrozole is also commonly used during an intrauterine insemination (IUI) cycle. Before IUI, you'll typically take either clomiphene or letrozole to stimulate your ovaries. Next, an injection of hCG is given, inducing ovulation. Then, sperm from a donor or a partner is collected, prepared, and placed into the uterus using a thin tube. An IVF cycle has several steps, including ovarian and pituitary suppression, ovarian stimulation, egg retrieval, egg fertilization in a lab, and the transfer of embryos into the uterus. Letrozole can be used in select patients as part of an IVF cycle to improve ovulation or impact the menstrual cycle to help make IVF as effective as possible.

Embracing Letrozole as an Effective Fertility Aid

Letrozole continues to be a safe and effective choice for many people struggling with infertility when used appropriately under the guidance of a fertility specialist. If you're coping with infertility, it's important to empower yourself with the knowledge to make the best decisions for your unique situation. 

Our caring team of fertility experts at Advanced Fertility Care is always here to answer any questions. We strive to provide compassionate, individualized care to support you in building a family. Contact us today to schedule a consultation.

Read More
Understanding Embryo Grading & How Embryologists Grade Embryos

Fertility Treatments

Understanding Embryo Grading & How Embryologists Grade Embryos

Embryologists and fertility doctors need an objective assessment guide to help them decide on the best embryos, the ones most likely to result in a pregnancy and a healthy baby, to transfer during the process of in vitro fertilization (IVF).

The number and quality of embryos a fertility doctor transfers influence the procedure's success rate. Transferring low-quality embryos may cause uterine implantation failure and ultimately hinder pregnancy.

This article discusses embryo grading, its criteria, the various grading systems available, and the role of embryo grading in IVF success rates.

What is Embryo Grading?

embryo grading

Embryo grading is a scoring system used by embryologists or fertility doctors to determine the quality of embryos before their use in treatment. Embryo grading provides the clinic with a priority guide as to which embryos to transfer.

During IVF, eggs are artificially inseminated inside the laboratory. After successful fertilization, the fertilized egg divides and grows to become an embryo. Before the embryos are utilized, the embryologist conducts a quality assessment using an embryo grading system. This grading system allows the embryologist to determine which embryos should be used for treatment and which should not be.

Is Embryo Grading Beneficial?

A study published in the US National Library of Medicine revealed that embryos with a higher grade had better clinical pregnancy and live birth rates compared to those with a poor grade.

Apart from an embryo grade, factors such as the genetic makeup of the embryo, laboratory conditions, experience, and skill of the fertility expert can influence the overall success of an IVF treatment. Genetics is the gold standard for embryo choice and truly drives success.

Notwithstanding, embryo grading still plays a role. Selecting only good-quality embryos provides the best opportunity that an embryo will be able to endure various types of possible treatments (e.g., PGT biopsy, cryopreservation, and thawing).

"Preimplantation genetic testing (PGT) is a more objective test while embryo grading comes from an embryologist’s subjective opinion," according to an Advanced Fertility Care embryologist. In recent times, PGT has taken over because we know that it is far more important than my subjective opinion," the embryologist further explained.

Criteria for Embryo Grading

A few hours after fertilization, the fertilized egg or zygote starts dividing to form a mass of cells that develops gradually into an embryo. The embryo cell number progressively increases within the first few days. 

The embryo cell number should be 2-4 cells after 48 hours and up to 7-10 cells by 72 hours.  Embryos are most commonly cultured to the blastocyst stage, which occurs between the 5th and 7th day of culture.

Grading Systems

There are different embryo grading systems, each focusing on specific characteristics of the dividing cells or blastocysts.

The IVF embryo grading system focuses on the following features:

  • degree of fragmentation and symmetry
  • the expansion rate and hatching of the blastocysts
  • inner cell mass
  • trophectoderm (a group of specialized tissues that differentiate and form the outer cell layer of a developing embryo.)

Generally, embryologists use the grading system based on the blastocyst expansion, inner cell mass, and trophectoderm for day five embryo grading. While day three embryo grading is typically based on the degree of fragmentation and symmetry.

Here are the common embryo grading systems most fertility clinics use to assess embryo quality before its transfer into the uterus for implantation.

Embryo Grading Based on Blastocyst Expansion and Hatching

Fertility specialists use the expansion rate of the dividing cells to score the embryo. It is also a numeric scoring system, and each embryo receives a score from 1-6.

The following is the numeric scoring system and its description using the blastocyst expansion and hatching feature:

  • 1: Blastocyst development and stage status
  • 2: Blastocoel cavity occupying more than half the volume of the embryo
  • 3: Full blastocyst with cavity completely filling the embryo
  • 4: Expanded blastocyst with cavity larger than the embryo and thinning of the zona pellucida
  • 5: Hatching out of the zona pellucida
  • 6: Hatched out of the zona pellucida

Embryo Grading Based on Inner Cell Mass

The inner cell mass is the group of cells in the developing embryo that transforms to produce the cellular structures that form a fetus.

Embryo grading using the inner cell mass is an alphabetical scoring system and includes the following:

  • A: Many cells, tightly packed
  • B: Several cells, loosely grouped
  • C: Very few cells

In this system, the quality of the inner cell mass reflects the quality of the embryo.

Embryo Grading Based on the Trophectoderm

A trophectoderm is a group of cells that are the first to differentiate and form the outer cell layer of a developing embryo.

Embryo grading using the trophectoderm entails:

  • A: Many cells forming a cohesive layer
  • B: Few cells forming a loose epithelium
  • C: Very few large cells

In this system, the embryologist uses the quality of the trophectoderm to assess the quality of the embryo.

Significance of Grades in Predicting IVF Success

Our embryologist also noted that: "just because an embryo looks good doesn't mean it's genetically normal, and just because it is a grade B doesn't mean it isn't normal. Today we use embryo grades as a way to demonstrate why an embryo was chosen to biopsy and/or freeze. The reason we do this is that poor quality embryos can't survive a biopsy and they also cannot survive the freeze and thaw process either."

Embryos with good grades have the potential to increase the chances of achieving pregnancy during an IVF treatment. In contrast, poor-quality embryos may fail to implant into the uterus, inevitably limiting IVF success.

Therefore, embryo grading provides fertility experts with the tool to make objective clinical decisions on the embryos to transfer.

Understanding Your Embryo Grade Results

Embryo grading will begin on day five. The embryos will be graded each day between day 5 and day 7. Any embryos deemed to be good quality will be utilized in treatment that day.  

Any embryos that are not chosen are allowed to continue to develop until day 7. The IVF lab routinely expects that approximately 50% of the embryos in culture will make good-quality embryos for use.

Interpreting Your Embryo Grading Report

Embryologists typically assign alphanumeric scores, such as 1AA, 2BA,3BC, etc., to embryos to indicate the quality level.

The following are possible embryo grade scores according to their exhibited degree of blastocyst expansion, inner cell mass, and trophectoderm grades:

  • High-quality embryos: ≥3AA
  • Poor quality embryos : 1–6BC, 1–6CB, 1–6CC

Of note, these embryo grades alone do not indicate failed IVF treatment. Other factors, such as an embryo's genetic makeup, medical history, or age, among other things, also affect your chances of achieving IVF success and pregnancy.

Do You Need Help with IVF Treatment?

Embryo grading is one of many tools that provides crucial information to fertility doctors to enable them to select suitable embryos for transfer. Transferring poor-quality embryos can reduce the success rate of IVF treatment.

If you intend to go for IVF treatment, consult an experienced fertility doctor and learn more about their embryo grading process.

Our team at Advanced Fertility Care has proven experience with IVF, and we use standardized embryo grading methods to assess quality before embryo transfer.

If you want to learn more about our process and IVF treatment, contact us or schedule an appointment with our team today. We look forward to supporting you in starting or building your family using IVF. We serve in different areas.

Read More
Why Male Infertility Evaluations Are So Important

Fertility Treatments

Infertility Resources & Support

Why Male Infertility Evaluations Are So Important

Why is Early Male Evaluation Important?


The realm of male fertility often remains shrouded in silence and stigma, despite its significance in the journey to parenthood for many couples. Recognizing and addressing male infertility through comprehensive evaluations is a crucial step in demystifying this issue, providing clear pathways to treatment, and, most importantly, offering hope and support to those affected.

Beyond the Basics: Understanding Male Infertility

Infertility is not just a woman's issue; it is a couple's challenge. Statistics reveal that in up to 50% of cases, male factors contribute to the couple's infertility. This highlights the necessity for thorough male fertility evaluations. Such assessments are pivotal not only in identifying potential fertility obstacles but also in debunking the myth that infertility is predominantly a female concern. By broadening the focus to include male reproductive health, we can foster a more inclusive and supportive environment for all individuals facing infertility.

The Process of Male Fertility Evaluation

Male fertility evaluations are important for identifying potential fertility issues, ruling out medical conditions, planning appropriate treatment, and providing emotional support for couples struggling with infertility.

Early evaluation answers some crucial questions:

  • Is the male a factor in the couple's infertility?
  • Can the male benefit from treatment? (About 20% respond to treatment)  
  • Are assisted reproductive technologies (ART) indicated?

The journey begins with a comprehensive evaluation designed to pinpoint the underlying causes of infertility. This process includes:

  • Medical History and Physical Examination: A detailed discussion of the individual's medical history, including any underlying health conditions, surgeries, or medications that could affect fertility. The physical examination can reveal varicoceles (enlarged veins in the scrotum) or other physical abnormalities that may impact sperm production or delivery.
  • Semen Analysis: The cornerstone of male fertility testing, semen analysis measures several key parameters, including sperm count, motility (movement), and morphology (shape). This test provides invaluable insights into the male partner's fertility status.
  • Advanced Testing: For some, further testing may be necessary. This can include hormonal evaluations, genetic testing to identify chromosomal anomalies or specific genetic conditions, and additional assessments like testicular biopsies or imaging studies.

Deciphering the Results: From Diagnosis to Action

The results of these evaluations can lead to a diagnosis that not only sheds light on fertility challenges but also opens the door to tailored treatment options. Whether the solution lies in lifestyle adjustments, medication, surgical interventions, or assisted reproductive technologies (ART) such as IVF or ICSI, the path to parenthood becomes clearer.

The Psychological Aspect: Addressing Emotional Well-being

An often-overlooked component of male fertility evaluations is the psychological impact. The process can stir a range of emotions, from anxiety and frustration to hope. Acknowledging and addressing these feelings is essential. Many fertility clinics and centers offer counseling services to support individuals and couples through their journey, emphasizing the importance of mental and emotional health in the context of fertility treatments.

Navigating Treatment Options: A Guided Path to Parenthood

A male fertility evaluation can help to determine the appropriate treatment for infertility. Treatment options may include lifestyle changes, medication, surgery, or assisted reproductive technologies such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intractyoplasmic sperm injection (ICSI). Understanding the underlying cause will help determine the best path forward and will guide your individual treatment plan.

The Bigger Picture: Fertility as a Shared Journey

Male fertility evaluations play a critical role in transforming the journey to parenthood from a solitary struggle into a shared experience. By actively participating in the evaluation process, men can take control of their reproductive health, contributing to a more balanced and inclusive approach to infertility.

Male fertility evaluations are a crucial step in breaking down barriers, addressing misconceptions, and opening the door to effective treatments. By prioritizing comprehensive assessments, we can support couples in their quest for parenthood, ensuring they have access to the care, information, and emotional support they need to navigate this complex journey.

Connect with our team today to start your journey to parenthood.

Read More
What is ICSI and Do I Need It?

Fertility Treatments

What is ICSI and Do I Need It?

What Is ICSI?

Intracytoplasmic sperm injection (ICSI) is a laboratory technique that offers a pathway to a successful pregnancy for couples with little hope of reproducing naturally or with IVF alone due to significant sperm issues. ICSI is the most used method that is a critical part of assisted reproductive technology. Its use accounts for 70% to 80% of the IVF procedures performed. 

For sperm to fertilize an egg, the sperm's head must attach to the outside of the egg. It then must break through to the inside, where fertilization takes place. If the egg's outer layer has become hardened or thickened, or if the sperm is abnormal and cannot swim effectively, it will be difficult for the sperm to penetrate it. 

Standard IVF vs. ICSI

Standard IVF vs ICSI intracytoplasmic sperm injection

In an IVF procedure, an egg is fertilized in a laboratory dish. Healthy sperm collected from the patient's partner or a selected donor is added to the dish to surround the egg. The sperm will naturally fertilize the egg by attaching itself to its outer membrane and breaking through into the egg. The fertilized egg (embryo) is transplanted into the uterus when it reaches a certain stage of development approximately five to six days after fertilization. If it implants into the lining of the uterus successfully, a pregnancy results. 

There are times, however, when surrounding the egg with sperm in the dish may not result in fertilization. Based on the circumstances or results of a prior semen analysis, doctors may opt for ICSI to help improve fertilization success. This procedure can frequently solve the issue of male factor infertility or poor fertilization in IVF cycles. ICSI is essentially an extension of IVF that works to control some of the variables that affect fertilization and increases the chances of an embryo resulting in pregnancy. 

How Is ICSI Performed?

ICSI is performed in conjunction with in vitro fertilization (IVF). Patients will undergo egg retrieval, and the egg will be injected with a single sperm in the lab through the process of ICSI with the hope of growing into a healthy embryo to be transferred to the carrying uterus.

Steps for Egg Retrieval

To prepare for egg retrieval, patients administer hormonal injections to stimulate the ovaries to produce multiple eggs for an average of 10 days, followed by an injection of human chorionic gonadotropin (hCG) or leuprolide acetate to assist in the eggs' final maturation.

When the eggs are ready for actual retrieval, a transvaginal ultrasound guides a thin needle through the vaginal wall into the ovary, then suction draws out and collects the eggs. This is performed under anesthesia and is a relatively short procedure lasting 10-20 minutes.

Unless frozen sperm is used, it is collected on the same day that egg retrieval occurs. The person supplying the sperm must collect ejaculate into a lab-provided container and deliver it to the lab within 30 minutes. The semen is analyzed for volume, mobility, and quality.

The ICSI Procedure

The ICSI procedure is performed with these steps:

1.    The embryologist holds the mature egg in a lab dish using a small glass tube equipped with a suction bulb.

2.    Using a thin needle, a single sperm is immobilized and picked up.

3.    The needle is inserted into the egg.

4.    The sperm is injected directly into the egg.

5.    The needle is withdrawn.

Now the waiting begins.

After the ICSI Procedure

Following the completion of the procedure, the embryology team monitors the embryos' progress to look for signs of successful fertilization. Cell division should begin within one day if the fertilized embryo is healthy. In many cases, the embryos are grown for five to six days, and at this point, if the patient elects to have preimplantation genetic testing performed (PGT) this is when the surviving embryos are biopsied (cells removed and sent for additional testing) and then frozen. 

If a fresh embryo transfer is performed, the developing embryo will need to grow appropriately for at least three to six days. When it is ready to transfer, a long, thin tube (catheter) is inserted through the vagina into the uterus under ultrasound guidance to inject the embryo into the uterus. The embryo must implant in the uterine lining for pregnancy to occur. If PGT testing is being performed, a frozen embryo transfer will be performed at a later date.

Who May Benefit from ICSI?

woman pregnant after doing IVF with ICSI

Male factor infertility is one of the causative factors in over one-third of male infertility cases. It usually results from complications in the sperm's production or delivery. In such a case, ICSI would be high on the list of options to overcome infertility. A man who has undergone a vasectomy reversal would also be a candidate for this procedure, even if the sperm is healthy otherwise. Other examples of infertility that may be helped through the ICSI procedure include:

•      Abnormal sperm motility. This references the sperm's ability to move effectively. 

•      Low sperm count. The male partner doesn't produce enough sperm for a successful attempt using artificial insemination or IVF.

•      Infertility that cannot be explained.

•      The semen lacks sperm because of a blockage in the reproductive tract of the male.

•      The sperm is unable to attach to an egg.

•      Traditional IVF has been unsuccessful, even with fit sperm.

•      The eggs used were matured in vitro.

•      The eggs were frozen before use.

Even when it isn't specifically indicated, some physicians may choose to use ICSI when appropriate. 

What Are the Risks of ICSI?

Compared to conventional IVF, some studies of the ICSI procedure suggest a possible connection between ICSI and an increased risk for intellectual delays, autism, chromosomal abnormalities, and birth defects such as Beckwith-Wiedemann syndrome, hypospadias, Angelman syndrome, and sex chromosome abnormalities. These are rare, occurring in less than 1% of babies conceived through ICSI with IVF. Other possible risks include:

•      Ovarian hyperstimulation syndrome in response to excessive fertility drugs 

•      Multiple births, either twins or triplets

•      Increased risk of premature labor and low birth weight

•      Slight increase in risk compared with IVF

•      The need for a cesarean section for delivery is slightly increased

ICSI Success 

On average, fertilization occurs through ICSI in 70% to 85% of cases. The rate of live births reflects the number of healthy children born following an IVF/ICSI cycle. These success rates are classified based on maternal age and will often vary due to additional factors affecting the eggs and sperm.

Take the First Step

If you'd like to learn more about IVF, ICSI, or other fertility treatments that may be a solution for you, contact the infertility specialists at Advanced Fertility Care to set up a consultation.

Read More