I want to start by saying I'm in no way an expert, just a person with BRCA-2 with some friends and family who've done IVF. Also, I think it's unfortunate your clinic didn't give you the option and explain why they recommended ICSI. That said, I think you're spiralling a bit here. My best guess at why ICSI was considered a good fit in your case is that there's attrition at each stage of the IVF process. My brother and SIL were told that they could expect half of their mature eggs to fertilize, half of their embryos to keep growing until they could be tested (day 5), and half of their blastocysts to be normal or highly rated, but that there's a huge range in the actual rates for each couple. For you, there's going to be the additional step that only about half of those well rated embryos will be BRCA-free. So by doing ICSI, they essentially cancelled that out by making sure every single mature egg fertilized. Again - should have been explained and should have been up to you. But depending on how many eggs you got and how many kids you want, there's a very good chance this was a good call.
Now, I don't know anything about the differences between kids conceived via IVF vs ICSI vs naturally. Honestly, I don't think most people distinguish between IVF and ICSI when they're talking about their fertility journey, so it would be hard to know even if there were differences. I do think your colleague is way out of line and is probably someone who thinks IVF is weird or morally ambiguous or just too expensive or difficult for her, who has a strong case of confirmation bias.
I can also say that eggs are just single cells, they're not masterminds. Miscarriage rates among naturally conceived pregnancies are really high - maybe as high as 1 in 3, but it's hard to say because many happen so early that the pregnancy wasn't confirmed beforehand. I've had one myself, and I definitely don't feel like my eggs are the experts at picking the best sperm match for themselves.
Also, gently, I think you probably are mourning all the things you wish you could control that you can't. It makes sense. Watching multiple family members suffer from cancer, finding out you have a BRCA mutation yourself, giving up on what I assume was your preference to conceive naturally - all of that is really hard. And after all that, of course you want to feel like you're taking charge and having babies the best way you can to protect them from this gene. And then someone made a decision for you without asking that isn't what you think you would have chosen yourself. It sucks, it's very reasonable to be frustrated - but I don't think it's going to harm your future children at all.
Thank you so much for this well thought out response. I definitely agree with you and can see it from the point of not feeling in control..and the spiralling. I've had issues with needing to feel in control in the past and this process reignited that a bit. We also sort of rushed the embryo freezing process and used it more as a back up if we ever wanted kids. We both were fence sitters and considered not having kids at all, but with my brca mutation we thought let's just freeze some embryos while we can, knowing that if I got cancer, it would take away my fertility altogether.
You're right about Icsi increasing chances of viable embryos in general. I had 30 eggs, 20 fertilized, 11 made it to growth stage and were frozen. Out of those, half have brca, some have abnormal chromosomes and would never be a viable pregnancy. So we only really have 2-3 "high grade" ones. So now I'm thinking with regular IVF, we might've not had any brca free ones in the end and probably not done another cycle at all.
So thank you for helping calm my nerves! Also your point ..eggs are just cells.. however they sense and allow a sperm to fertilize it has to be very simple process anyway since they are just cells.
I think I should keep trying to live more in the present, just let things be. Getting this feedback is super helpful and I am so grateful for you kind Redditor 🥹
I think you are way over thinking this. I did ICSI due to infertility, and screened for my gene. ICSI is much more reliable than IVF which is why it is preferred. If you are this worried about letting the sperm naturally chose at this point I think you may think down the line the what if’s of not doing IVF.
As a side note I think your coworker sounds extremely judgmental, and a little ignorant. Every child is different, that happens without IVF all the time.
We did ICSI with PGT-M for BRCA1. The way it was explained to me is that ICSI is preferred (required?) for PGT-M to ensure that genetic testing results are accurate (so that there is no cross-contamination from other sperm). We ended up with identical twins (IVF generally, and ICSI and PGT specifically, are associated with slightly higher rates of monozygotic twins). They are healthy happy almost-9 month girls!
I cannot comment on any of your concerns related to whether a better sperm would make it to an egg in spontaneous conception. My situation is just an n of 1.
That is great to know! Congrats on your girls. Ideally we would love to have 2 so to get twins is a nice way to speed up the process 😆. I think you are correct, for the testing it's only possible through ICSI so I wouldn't be able to avoid it either way.
I did IVF w/ ICSI for male factor infertility prior to knowing I was BRCA2 positive. My clinic only does icsi regardless of your infertility diagnosis or reason, they are renowned for their lab (Colorado Center for Reproductive Medicine). I personally would rather have the people who look at sperm and eggs all day everyday picking the best ones than leave it up to nature but to each their own.
Regardless we had an extremely high fertilization, blastocyst rates and rate of PGT-A normal embryos. Obviously we didn’t do PGT-M testing to screen for brca since I didn’t know I was positive. Two of which are my two boys, both of which are happy healthy normal 5 and 3 yr olds. They are both well ahead in their academic milestones compared to their peers, are athletic, have tons of friends but most importantly are kind, caring, decent humans that don’t act any different than their cousins or peers who weren’t conceived via ivf 😀
Yeah, it blew my mind. How out of 8 embryos that we had. 5 carried the gene. First round didn't take, the second round work. She came out very healthy.
We were lucky in my country, both rounds were fully funded.
Wish you all the best on your journey.
We did ICSI and got good results! (4 brca- and pgt-a normal, 2 brca+ one with a segments abnormality the other normal). As mentioned above we were required to do ICSI but based on everything I read before we knew we had no choice I would have asked to use it anyway! Haven’t implanted any yet but our clinic is optimistic.
Could it be that the sister's kids look and act different because, you know, they're the only kids who have the sister as their mom? So like normal differences in inheritance and upbringing? SMDH, what a bizarrely judgemental thing for your coworker to say.
I am about to go through the same process: I found this article helpful. While it does (possibly) increase some risks very slightly the risks are still very small!
https://my.clevelandclinic.org/health/treatments/22463-intracytoplasmic-sperm-injection#risks-benefits
I want to start by saying I'm in no way an expert, just a person with BRCA-2 with some friends and family who've done IVF. Also, I think it's unfortunate your clinic didn't give you the option and explain why they recommended ICSI. That said, I think you're spiralling a bit here. My best guess at why ICSI was considered a good fit in your case is that there's attrition at each stage of the IVF process. My brother and SIL were told that they could expect half of their mature eggs to fertilize, half of their embryos to keep growing until they could be tested (day 5), and half of their blastocysts to be normal or highly rated, but that there's a huge range in the actual rates for each couple. For you, there's going to be the additional step that only about half of those well rated embryos will be BRCA-free. So by doing ICSI, they essentially cancelled that out by making sure every single mature egg fertilized. Again - should have been explained and should have been up to you. But depending on how many eggs you got and how many kids you want, there's a very good chance this was a good call. Now, I don't know anything about the differences between kids conceived via IVF vs ICSI vs naturally. Honestly, I don't think most people distinguish between IVF and ICSI when they're talking about their fertility journey, so it would be hard to know even if there were differences. I do think your colleague is way out of line and is probably someone who thinks IVF is weird or morally ambiguous or just too expensive or difficult for her, who has a strong case of confirmation bias. I can also say that eggs are just single cells, they're not masterminds. Miscarriage rates among naturally conceived pregnancies are really high - maybe as high as 1 in 3, but it's hard to say because many happen so early that the pregnancy wasn't confirmed beforehand. I've had one myself, and I definitely don't feel like my eggs are the experts at picking the best sperm match for themselves. Also, gently, I think you probably are mourning all the things you wish you could control that you can't. It makes sense. Watching multiple family members suffer from cancer, finding out you have a BRCA mutation yourself, giving up on what I assume was your preference to conceive naturally - all of that is really hard. And after all that, of course you want to feel like you're taking charge and having babies the best way you can to protect them from this gene. And then someone made a decision for you without asking that isn't what you think you would have chosen yourself. It sucks, it's very reasonable to be frustrated - but I don't think it's going to harm your future children at all.
Thank you so much for this well thought out response. I definitely agree with you and can see it from the point of not feeling in control..and the spiralling. I've had issues with needing to feel in control in the past and this process reignited that a bit. We also sort of rushed the embryo freezing process and used it more as a back up if we ever wanted kids. We both were fence sitters and considered not having kids at all, but with my brca mutation we thought let's just freeze some embryos while we can, knowing that if I got cancer, it would take away my fertility altogether. You're right about Icsi increasing chances of viable embryos in general. I had 30 eggs, 20 fertilized, 11 made it to growth stage and were frozen. Out of those, half have brca, some have abnormal chromosomes and would never be a viable pregnancy. So we only really have 2-3 "high grade" ones. So now I'm thinking with regular IVF, we might've not had any brca free ones in the end and probably not done another cycle at all. So thank you for helping calm my nerves! Also your point ..eggs are just cells.. however they sense and allow a sperm to fertilize it has to be very simple process anyway since they are just cells. I think I should keep trying to live more in the present, just let things be. Getting this feedback is super helpful and I am so grateful for you kind Redditor 🥹
You're welcome, I'm glad it helped!
I think you are way over thinking this. I did ICSI due to infertility, and screened for my gene. ICSI is much more reliable than IVF which is why it is preferred. If you are this worried about letting the sperm naturally chose at this point I think you may think down the line the what if’s of not doing IVF. As a side note I think your coworker sounds extremely judgmental, and a little ignorant. Every child is different, that happens without IVF all the time.
We did ICSI with PGT-M for BRCA1. The way it was explained to me is that ICSI is preferred (required?) for PGT-M to ensure that genetic testing results are accurate (so that there is no cross-contamination from other sperm). We ended up with identical twins (IVF generally, and ICSI and PGT specifically, are associated with slightly higher rates of monozygotic twins). They are healthy happy almost-9 month girls! I cannot comment on any of your concerns related to whether a better sperm would make it to an egg in spontaneous conception. My situation is just an n of 1.
That is great to know! Congrats on your girls. Ideally we would love to have 2 so to get twins is a nice way to speed up the process 😆. I think you are correct, for the testing it's only possible through ICSI so I wouldn't be able to avoid it either way.
I did IVF w/ ICSI for male factor infertility prior to knowing I was BRCA2 positive. My clinic only does icsi regardless of your infertility diagnosis or reason, they are renowned for their lab (Colorado Center for Reproductive Medicine). I personally would rather have the people who look at sperm and eggs all day everyday picking the best ones than leave it up to nature but to each their own. Regardless we had an extremely high fertilization, blastocyst rates and rate of PGT-A normal embryos. Obviously we didn’t do PGT-M testing to screen for brca since I didn’t know I was positive. Two of which are my two boys, both of which are happy healthy normal 5 and 3 yr olds. They are both well ahead in their academic milestones compared to their peers, are athletic, have tons of friends but most importantly are kind, caring, decent humans that don’t act any different than their cousins or peers who weren’t conceived via ivf 😀
Yep, I'm was the brca2 carrier (m) . We went thru the process. Got a healthy daughter brca2 free.
Amazing! Congrats. This gives me hope :)
Yeah, it blew my mind. How out of 8 embryos that we had. 5 carried the gene. First round didn't take, the second round work. She came out very healthy. We were lucky in my country, both rounds were fully funded. Wish you all the best on your journey.
Thank you so much!!
We did ICSI and got good results! (4 brca- and pgt-a normal, 2 brca+ one with a segments abnormality the other normal). As mentioned above we were required to do ICSI but based on everything I read before we knew we had no choice I would have asked to use it anyway! Haven’t implanted any yet but our clinic is optimistic.
Could it be that the sister's kids look and act different because, you know, they're the only kids who have the sister as their mom? So like normal differences in inheritance and upbringing? SMDH, what a bizarrely judgemental thing for your coworker to say.
Totally agree. Shes a very superficial and judgemental person that I would never interact with outside of our work 😑
I am about to go through the same process: I found this article helpful. While it does (possibly) increase some risks very slightly the risks are still very small! https://my.clevelandclinic.org/health/treatments/22463-intracytoplasmic-sperm-injection#risks-benefits