ICSI Failure

Intracytoplasmic sperm injection (ICSI) has revolutionized fertility treatments by offering hope to countless couples struggling with male infertility. However, despite its advanced techniques and promising success rates, ICSI doesn't always deliver the desired outcome. When an ICSI cycle fails, it can be a deeply frustrating experience, leaving couples grappling with questions and uncertainty.

If embryos are transferred and pregnancy does not occur after ICSI, there are several possible reasons. Most often, failure is due to a problem with the embryos implanting in the uterus, but determining the exact cause can be complex. Failure may be due to embryo problems, such as chromosomal or genetic abnormalities that impede normal development. Alternatively, it could be due to a problem with the uterine environment, which may affect the embryos' ability to implant successfully.

• Intracytoplasmic sperm injection (ICSI) is an effective infertility treatment that involves inserting live sperm directly into an egg in the laboratory. This procedure can lead to the formation of an embryo, a fertilized egg, and is considered a form of in vitro fertilization (IVF).

• Intracytoplasmic sperm injection (ICSI) involves extracting eggs from the ovaries after stimulation and then fertilizing them with sperm. The fertilized egg is known as an embryo. After ICSI, the doctor monitors the fertilized egg in the laboratory for signs of successful fertilization. The embryo can be frozen for storage or transferred to the uterus. 

• Over the next five to six days, the fertilized egg must divide to form a blastocyst. The doctor assesses its size and cell mass to determine the optimal time for transfer. Embryo transfer to the uterus can be performed on either day five or six after egg retrieval. For pregnancy to occur, the embryo must successfully implant in the uterus.

Several factors may contribute to the failure of IVF, including the following:

• Age plays a vital role in determining the quality and quantity of eggs a woman has. As she ages, the number of eggs naturally declines, and their quality deteriorates. This decline in egg quality and quantity significantly impacts the chances of pregnancy, increasing the likelihood of problems with fertilization and fetal development.

• This decline correlates with a decrease in the antral follicles and anti-Müllerian hormone (AMH) levels, as both follicle count and AMH levels are directly related to age. Therefore, aging may lead to decreased ovarian function, making achieving pregnancy via ICSI more challenging.

• An increased BMI, especially above 30, can significantly reduce fertility and pregnancy rates. In women, a high BMI may be associated with ovulation problems, increasing the risk of miscarriage and infertility.

• For men, obesity negatively affects the reproductive system, as obesity reduces testosterone levels, which can negatively impact fertility and reduce the chances of successful fertilization.

• Some abnormalities, such as endometriosis, can significantly affect the ability of embryos to implant in the uterine lining. Endometriosis causes tissue similar to the uterine lining to grow outside the uterus, leading to inflammation and changes in the uterine environment. This makes it difficult for embryos to attach and develop properly after being transferred to the uterus.

• In addition, factors such as endometrial inflammation, immune problems, and blood clotting abnormalities may contribute to IVF failure. The presence of some small fibroids, which are difficult to detect by ultrasound, can cause frequent uterine contractions, which hinders embryo implantation and increases the likelihood of ICSI failure.

• Although ICSI can be effective even in cases of low sperm count, other factors affect the fertilization rate and require attention when planning a new attempt.

• These factors include sperm abnormalities, such as fragmented genetic material and poor motility, which can significantly impact fertilization success. It's essential to address these issues before attempting treatment again to ensure the best chance of success.

• Embryos that reach the blastocyst stage are classified based on their degree of development and cell quality. Higher-quality embryos have a greater chance of successful implantation and pregnancy.

• Embryos often face genetic abnormalities that occur during their development, and women over the age of 35 are more susceptible to these problems.

• In addition, immature embryos and their early transfer to the uterus shortly after fertilization may lead to the failure of the ideal interaction between the uterine lining and the embryo, causing implantation failure and loss of pregnancy chances.

• The embryo is considered a foreign body to the mother's body, and the uterine lining may sometimes reject it. Diagnosis of this problem is usually by ruling out other causes and testing for immune antibodies.

• Implantation failure may result from an immune system dysfunction, such as antibodies against the embryo or abnormal immune system activity that may attack the embryo in its early stages, preventing it from attaching to the uterine lining. Various immunotherapies are available to increase the body's acceptance of the embryo and enhance success rates.

• Blocked and inflamed fallopian tubes negatively impact the success rate of ICSI, with decreased implantation rates observed. Therefore, it may be necessary to treat the inflamed tube before initiating the ICSI procedure.

• The only definitive way to determine that embryo implantation has occurred is to perform a pregnancy test, which can be either a urine test or a blood test to measure the level of human chorionic gonadotropin (HCG), and must be performed two weeks after embryo transfer.

• Cramping or pain after an ICSI procedure may be a potential indicator of a failed procedure. However, it's important to note that mild discomfort and cramps can also occur in successful ICSI procedures.

• The presence of some symptoms that may resemble those of early pregnancy, such as abdominal discomfort, nausea, or fatigue, does not guarantee a positive outcome. These symptoms may be caused by the medications used in the treatment, even if pregnancy does not occur. On the other hand, the absence of symptoms does not rule out the possibility of pregnancy, as early pregnancy can be asymptomatic.

After a failed ICSI procedure, many people wonder about the next steps, including:

• It is usually recommended to wait 4 to 6 weeks before starting a new ovarian stimulation strategy and retrying an ICSI cycle.

• During this period, the medical team will determine the reason for the negative pregnancy test result, allowing you to make a clear decision and give your ovaries a period of rest after the previous stimulation.

• Regarding the ovarian response to re-stimulation, the next attempt can be adjusted and customized based on the ovarian response in the previous cycle and hormone levels. Additionally, progesterone levels play a key role in assessing whether the uterine lining is optimal for receiving an embryo.

• The medical team will address any factor that caused the ICSI failure, such as treating blocked fallopian tubes or improving sperm quality.

After a failed ICSI procedure, a series of tests can help identify potential issues and guide future treatment strategies. Here are some important tests to consider:

• Women undergoing ICSI undergo regular evaluation of the uterine lining using ultrasound, but these tests alone may not be sufficient if ICSI fails.

• Studies indicate that many women who undergo ICSI may have uterine problems that are only detected through additional testing.

• The use of diagnostic hysteroscopy in cases of previous ICSI failure has improved pregnancy rates due to its ability to detect underlying conditions that can impact treatment success. For example, hysteroscopy can detect and remove uterine polyps, treat intrauterine adhesions, and treat chronic endometriosis, significantly improving fertility outcomes.

• This test evaluates the uterine lining's readiness for embryo implantation. Studies indicate that women who experience repeated ICSI failure may have abnormalities in gene expression related to the endometrium's receptivity to embryos.

• The ERA involves taking a small biopsy of the uterine lining for genetic analysis, focusing on a group of genes related to the uterine lining's ability to receive an embryo.

• By studying these genes, ERA accurately determines the state of the uterine lining and its stage of readiness at the time of sampling. This data provides vital details for timing embryo transfer, helping align the procedure with the optimal embryo acceptance chances.

• Sperm DNA fragmentation analysis is a male fertility test that measures the amount of damaged DNA in a sperm sample. 

• Naturally, all men have some degree of damage to their sperm DNA. However, high levels of damage may indicate more difficulty in achieving and maintaining pregnancy.

A failed ICSI cycle isn't the end of the road to achieving your dream of having a baby. Many couples experience unsuccessful attempts before achieving pregnancy. A specialist can assess your chances of conceiving after a failed ICSI cycle. For more information, contact MedTripFinder.