Who needs IVF /ICSI
1. Tubal blockages …if both tubes are blocked or removed mainly for both side ectopic pregnancy …IVF/ICSI is the only way ahead for pregnancy.
Some times only one tube is pathologic then it’s the duration of infertility ,associated low ovarian reserve decide urgency of pregnancy . this situation will be more benefitted with IVF/ICSI .
Laparoscopy report of tubal status is the gold standard …if laparoscopy mentions dilated tubes , terminal hydrsalpinx , delayed spill , peritubal adhesions , thickened tubes this representes non correctable tubal problems though the tubes are open. Many of these couples will be benefitted most by IVF/ICSI since partially pathologic tubes will delay the pregnancy and chances of tubal ectopic pregnancy are high.
2. PCOS …PCOS per say is not an indication for ICSI but if PCOS lady has husband with oligospermia , associated endometriosis , multiple failed IUI > 4 then ICSI is best choice. Few women with PCOS have a severe disease diagnosed by high AMH > 9 , LH > 12, High BMI > 35, longstanding PCOS are benefitted most by IVF/ICSI .
PCOS women who have not responded to repeated ovulation induction cycles , married > 6 years deserve an IVF/ICSI cycle for faster pregnancy.
3. Low sperm count ….sperm count lesser than 5 million are most benefitted by ICSI . we calculate TMSC ..TOTAL MOTILE SPERM COUNT if its less than 5 then ICSI is chosen.
4. Failed IUI …Unexplianed infertility. Most couples with unexplained infertility will do IUI cycles as firstline therapy. After 3-4 failed iui cycles couple will need iICSI. we are not aware at IUI if sperm s met the eggs , what was egg quality , embryo quality etc . ICSI throws alight on all these aspects so failed IUI couples are benefitted by IVF / ICSI .
5. Low ovarian reserve ….women with AMH < 1.2 , FSH > 8 have less time left for conception and there fertility potential is seriously low . This demands expedite pregnancy which is better achieved by IVF/ICSI.
6. Endometriosis ….women suffering from endometriotic chocklate cysts need IVF /ICSI as best treatment . these women commonly have low ovarian reserve , poor egg quality and adhesions in pelvis not allowing natural pregnancy.
7. Adenomyosis…uterine muscle layer is thickened in adenomyosis which does not allow pregnancy naturaly . IVF/ICSI with frozen transfer cycle allows medications like ZOLADEX / LUPRIDE which decrease the thickness and help achieve pregnancy faster .
8. Erectile dysfunction ….many refractory cases of erectile problems will be benefitted by ICSI since this is a quick fix.
9. Azzospermia …no sperms in semen will be benefitted by TESA /TESE + ICSI .hormonal reports of husband are important.
10. Egg donation ….women with age > 38 may have very low ovarian reserve of may be menopausal , these women will need ICSI with donor eggs.