Over 2 decades ago, ICSI (intracytoplasmic sperm injection) revolutionized the treatment of male infertility. The ICSI procedure involves injection of a single sperm into each egg at the time of IVF (in vitro fertlization). Before the development of ICSI, couples with sperm issues, what we call "male factor," had very low fertilization and pregnancy rates, even when undergoing IVF. Now a days, because of the use of ICSI, poor sperm quality is a very unusual reason for an IVF cycle to be unsuccessful or to blame for poor fertilization. Over concerns about potentially poor fertilization, many fertility centers have chosen to use ICSI routinely to ensure optimal fertilization even when the male partner's sperm is perfectly normal. At Princeton IVF, our philosophy has always been to allow fertilization to happen "naturally" in the dish when there is no history of sperm issues or poor fertilization. While ICSI had been shown to be quite safe, we feel that a more natural selection process makes more sense and research in the past has suggested that ICSI is only beneficial in male factor patients. A recent large-scale study recently published in the Journal of the American Medical Association has borne this out. ICSI when used in IVF cycles used in couples without sperm issues had lower fertilization and lower implantation rates than non ICSI cycles.
In recent years, endometrial scratching, irritating the endometrium (lining of the uterus) to help in making the womb more receptive for pregnancy has emerged as a new and unsual way to help couples get pregnant. Recently, a group from Turkey presented data at the American Society of Reproductive Medicine meeting suggesting that performing an endometrial biopsy prior to IVF can improve pregnancy rates in women undergoing IVF by about 20%. In fact over the years, seeming against common sense, there have been a number of studies suggesting that a biopsy and/or hysteroscopy may improve the chances for IVF success. At Princeton IVF, we have been using this technique for years, first in patients who failed cycles without any good explanation and then routinely in all our IVF patients. Although no one is quite sure why it helps, it is likely that the repair process from endometrial trauma helps to make the uterus more receptive to embryos.
Many IVF and fertility practices such as ours use a procedure called PICSI to help certain couples where we are concerned that there may be a problem with sperm quality even when fertilization is succesful with ICSI. PICSI relies on placing the sperm on a field hyaluronic acid and having the embryologist determine whether sperm are able to bind to it. Sperm which are immature or otherwise abnormal are less likely to bind to the hyaluronic acid, and so sperm which do bind to it are used for the injection into the egg for ICSI. We and others have found that it may help certain couples who have failed ICSI cycles or had miscarriages from ICSI cycles. However, to date there are no large studies yet showing how effective it is, so researchers at the University of Leeds in the UK have initiated a large study to determine this.
As a fertility specialist, one of the most devastating diagnosis I can deliver to a patient is that she has ovarian insufficiency or ovarian failure, essentially meaning that she in premature menopause. While these women are usually able to bear children with the use of donor eggs, the chances for pregnancy with their own eggs are extremely low. As highlighted in a recent issue of Time magazine, researchers at Stanford have attempted to reinvigorate their ovaries using a procedure called In Vitro Activation (IVA) . Of the 27 couples in trial, 2 actually became pregnant. While the odds for pregnancy were quite low, this represents a glimmer of hope for women with ovarian insufficiency.