# ICSI Blast confusion



## Annaleah (May 14, 2008)

Hi all,  
Been absent for a little while regrouping after last abandoned IUI cycle due to high response.  Cons suggested either IUI with lower FSH dose (I was already on a much lower dose than most) or IVF.  I've decided to opt for IVF which was due to start late Sept or this month (if they had any cancellations).  Got a cancellation today so looks like i'll start down regging on 24th..anxious and excited   and not looking forward to the inevitable rollercoaster, weeks of juggling work and 4hr round trips to the clinic!!  but ......feeling positive.

Clinic have gone through extra costs for ICSI and of taking the embbies to blastocyst stage and have asked me to decide whether I would like to have these options so they can book the theatre and lab times out now...how on earth do I make this decision (it all just feels like statitistics to me!!  )
Any thoughts?  This will be my first IVF and a little part of me thinks to go all out and ICSI the eggs, take them to blasts on the assumption that I will really increase my chances, but then i cringe at the cost. Annaleah x


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## Annaleah (May 14, 2008)

Hi Rose, Thanks for the info -i'd forgotten frozen sperm are sluggish, they had mentioned that to me before the IUI.  I'm due for LP IVF starting Sunday (joyfully the day of a big family 80th birthday do in London).  There'll no doubt be chaos that day but at least stuff to take my mind off starting.  I'm going down to Bourn to collect the nasal spray on Thursday.  The prices I have been given are £900 for ICSI, £800 for blasts (which is on top of the IVF, sperm and drugs costs).  Sounds like Bourn are comparatively much dearer on ICSI cost than your clinic!  I probably will have questions about the process once I start and am quite anxious about OHSS given my response to the low dose FSH for IUI but the clinic, i'm sure, will keep a close eye.  
Thanks, Annaleah x


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## suitcase of dreams (Oct 7, 2007)

Hi Annaleah, 

This is a difficult one - seems odd that they are asking you to make a decision on this now without waiting to see how you respond/what the sperm sample is like etc

On my first IVF I had 21 eggs, ICSI was recommended and 14 fertilised. 2nd IVF I had 20 eggs, no ICSI, and 14 fertilised. So just goes to show ICSI isn't always needed - it was recommended first time because of sperm sample, but different donor second time and not recommended. Both times I left it to the experts (ie the embryologist) to recommend the best course of action.

Can't help re blasts I'm afraid - I wasn't in a position to go to blast on either occasion - I think you need a lot of embies for them to recommend this - first cycle I only had 2 good ones, 2nd cycle I had 5 - 2 went back in, 3 frosties are being defrosted for the two best to go back in next week....Muddy can prob help with blasts though as I know she went to blasts successfully on last cycle...

All the very best with your cycle
Laura
x


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## dottiep (Nov 20, 2007)

Hi Annleah

It's a hard one isn't it??  I remember trying to decide when I was at LWC if it was worth paying the extra - luckily at Reprofit there is no real difference in cost.  This is a very expensive journey we have embarked upon.  For what it's worth I would do everything that could help the outcome.  Good luck with whatever you decide.

dottie
x


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## Annaleah (May 14, 2008)

Thanks Laura, and good luck with the transfer next week.  The clinic told me I would need a minumum of 6 good embies to go to blast as there is a 40% loss rate.  I will ask clinic on Thursday whether they can advise about ICSI based on quality of sample once defrosted - I know I would rather let the experts decided, that way I have to worry less about the impact of my decisions on the outcome. 
Dottie - there's a big part of me that agrees with you about doing everyting possible to make it work (and that's been my attitude all along).  I think the potential mounting costs just frighten me, maybe it's because my car has just gone to car heaven via the MOT route and i'm just in the expensive process of getting another.  I'm probably just money worried because of this recent little reminder of life's hidden costs! 
Annaleahx


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## suitcase of dreams (Oct 7, 2007)

Annaleah - I know exactly what you mean - my car recently cost me near enough £1000 after the fuel pump kept failing....eventually they discovered it was contaminated fuel.....

I think you should def pay the extra if the experts recommend, but they need to be able to give you good reasons for the recommendation and not expect you to be able to decide this for yourself. So I think you should tell them in principle you are happy to go with ICSI/blasts if that's what they recommend to maximise your chances of success but that you'd like them to help you make the right decision by making clear recommendations - I've found clinics reluctant to do this but to my mind that's exactly what we are paying for - their expert advice and treatment...

Good luck
Laura
x


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## ♥JJ1♥ (Feb 11, 2006)

Annaleah Glad that you have a plan worked out- it is unfair to push you into deciding and a bit unethical I think. When I was at the Bridge they were pushing me for blasts, assisted hatching and PGD, and in fact none of my embryos ever made it to blasts or good enough for freezing. So the blastocycts will be self determined, I would kill to have blasts each time and why would they not want you to have the best chance of pregnancy. PGD and assisted hatching also not options for me as I never produced enough and you should have at least 10 as they can damage the embryos when doing both.

The icsi is also on the day when they defrost the sperm and see what is happening. I would question their motives at this early stage and asking you to decide. Some European clinics ICSI routinely.

ICSI is also not without its controversy, I have to have it as we have a low sperm count to work with so no option, but there are studies about developmental delay- in fact I worked with Dr Sutcliffe who did the studies, but by the age of 5 it appears that developmentally ICSI and naturally conceived children are the same.
http://www.bupa.co.uk/health_information/html/health_news/070703ivf.html

ICSI is more expensive but usually you get higher fertility rates, you can also so half IVF and half ICSI
not sure what they charge for that.

Good luck
L x

/links


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## muddypaws (Apr 10, 2008)

Hi Annaleah,
I had a look at your clinics website and it does look a little expensive compared to some (well to mine anyway!). In terms of ICSI, I have been told that they use this because frozen sperm is usually more sluggish but other clinics would disagree that this is always necessary. There are risks: i.e. damage to the eggs but this will all depend on how good the embryologists are. I've had ICSI both times and have had a high initial fertilisation rate, although one might consider it low when looking at the number of eggs that I get (17 and 27 eggs with 13 and 14 fertilised). 

I kind of understand what they are saying about lab time because it does obviously take more time for ICSI and blast culture. However, as everyone else has said, I'm not sure how they can ask you to decide about blasts in advance. I am lucky that at my clinic there isn't an extra charge for blast development, which appears to be unusual. Sounds like thay have the same policy as most places in terms of going to blast only when there are a larger number of fertilised embryos. I had 11 and went to blasts, which was incredibly nerve racking. I ended up with 6 blasts, which is pretty much as good as the general stats suggest. However, you have to consider that you could end up with none or only a very small number. My thinking was that if they don't make it that far then maybe they wouldn't have survived anyway and you could end up wasting time and money on 2ww that wouldn't ever have worked. I know that other clincs have a different view; some think that the best place for embryos is in the womb and don't go to blast at all. Others will go to blast if at all possible, due to higher pregnancy rates. I have also heard the view that blast development isn't advised in older ladies. However, as you can see I am in that category and got good results, albeit no bfp so far.

It is a minefield but with regards to blasts, if you get enough and can bear the anxiety of waiting for them to develop or not then maybe it is possible to say now that yes you would go for this option if it looks good but not if it feels too difficult. They won't hold you to your original decision if you change your mind I'm sure... Perhaps best to say yes because if you say no and they say they don't have the time to go to blasts/ICSI last minute if you change your mind you might end up disappointed. They must be packing ti all in very tightly though if they need you to book lab time now. 

You could go for a split option - if you get enough eggs, freeze some on day three and take others to blast. You can take day 3 frozen ones to blast at a later stage anyway. Not sure about freezing success etc, but I have 4 blasts frozen and have been told that they have a good chance of surviving due to the fact that they are well developed at this stage and thus tougher but have also heard the opposite!!! No hard and fast answers then.... 


Not sure if this helps at all!! ...PM me if you want to chat more about it but I'm no expert...it's all so confusing isn't it?

Good luck with decision-making!

Muddylane


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## ♥JJ1♥ (Feb 11, 2006)

This might help http://www.fertilityfriends.co.uk/forum/index.php?topic=153629.msg2381781;topicseen#msg2381781


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