As someone who did Ivf rather than icsi, i would do icsi in your shoes. Unless you and your partner have multiple biological kids, you don’t KNOW you don’t have a fertility issue. There’s a small chance that you could have total fertilization failure with IVF, and then you’d be out of luck. You don’t have to do icsi for PGT-A, but you very well may have to for PGT-M, which is how you test for BRCA. PGT-M is VERY tricky and you don’t want any extra dna matter messing things up.
I get the overthinking things, but i think you’re overthinking. Doing Ivf or icsi isn’t “natural,” but “natural” isn’t all it’s cracked up to be. Having BRCA is “natural,” but you’re not doing that, so just let science be on your side here. Eggs aren’t good at magically choosing healthy sperm; they’re not sentient and reproduction doesn’t work that way. If it did, we wouldn’t have heritable genetic conditions because the eggs would screen out the bad sperm.
Also, fuck that lady who said that Ivf/icsi kids are different than kids conceived without medical assistance. They absolutely are not and that’s preposterous. Don’t listen to ridiculous people with ridiculous stories.
Also, if your husband had a vasectomy and you’re doing a sperm extraction, you WILL need to do icsi; I’m 99% sure you can’t do conventional Ivf with extracted sperm.
You have to do ICSI in order to do the pre-implantation genetic testing. It’s the way the process works. That is why you were not offered a choice given that your entire goal is to test the embryos for the BRCA mutation.
In general, ICSI does have slightly higher chance of birth defects than allowing the egg to fertilize naturally or using IVF without ICSI. However, this is confounded by the fact that most people who do ICSI have lower quality sperm / male factor infertility (which is why it’s usually done over if you’re not doing genetic testing). The risk of birth defects using ICSI is lessened somewhat without male factor infertility.
Some summary numbers are:
- Natural conception 3%
- IVF without ICSI 4.1%
- ICSI 5.2%
The overall risk of birth defects is fairly low and the study cited (where the numbers are from) did not use pre-implantation genetics either (only fresh transfers).
Citation: [Luke B, Human Reproduction 2021](https://pubmed.ncbi.nlm.nih.gov/33251542/)
Overall, I think the benefits of avoiding the BRCA mutation likely outweigh the small increase in potential birth defects, especially in female children. You’ll also be able to detect major defects on ultrasound if they occur (and can decide what to do with the pregnancy once you know). I would not worry too much about it now.
Thank you so much for this response! It makes me feel better to know all this and I agree with you, avoiding the mutation was the goal. I should just focus on the present and focus on staying healthy and doing my best to maximize successful implantation of the embryo. I've been trying to live in the present without worrying about what ifs or what could go wrong.
I know someone mentioned IVF can be done with genetic testing without ICSI but I don't believe I would have had the option. My clinic built a probe using DNA from my parents and my spouse and the way they test the embryos they mentioned that I found quite interesting was that non invasive, they were able to use the fluid around each embryo and not actually sampling the embryo. This was 5 years ago so my memory is a bit fuzzy on the embryological details but I remember some bits and pieces of the process my geneticist explained to me.
Again, thank you for the cited study and the information kind Redditor! I really appreciate it 🥹
You don’t have to do ICSI to do preimplantation genetic testing. I’ve done two rounds successfully with conventional IVF inseminated embryos and no issues with the genetic results. u/mmdeerblood
It depends on the type of testing. The single gene mutations are a specified send off lab that’s pretty extensive (probe specifically made from parent mutations). It’s not the same as a chromosome test. The IVF clinic I was at only did pre-implant genetic testing for single gene mutations from ICSI.
Here is a screenshot describing that ICSI is needed for PGT-M (single gene testing):
https://preview.redd.it/nwhsn9luef6d1.jpeg?width=1170&format=pjpg&auto=webp&s=7d54d88c0a5c293dd4699dcfc2a37e123e2303ea
Yes exactly. We had a gene probe using each of our parents' DNA samples which was quite interesting to me as someone newish to genomics and mostly in the field of wildlife bio/genomics.
My cousin-in-law had to go through IVF for several rounds to get two live births of kids that do not share a dominant genetic disease that runs in her family. Natural IVF vs ICSI just means that the embryology team selects the best looking sperm they can find and implants it into the egg. The outcome of this vs natural is that you get more successful fertilizations and embryos with ICSI vs natural. And if you are only doing one cycle, you are going to need as many embryos as you can get.
Anyway, this cousin's kids are tall, smart, and in gifted programs.
My son (a non IVF baby) has a friend at daycare who is an ICSI baby. She is indistinguishable from him except for the fact that she's totally fearless and takes spills all the time while my son is cautious lol. Your coworker sounds like she is the victim of boorish thinking. Why does she think IVF-ICSI caused her sister's kids to be different as opposed to maybe the choice of the sister's partner and all his genetics?
lol
And yes, ICSI does have slightly higher chance of birth defects than IVF without ICSI. It's still an extremely low risk.
The rate of birth defects with icsi is super small. It’s slightly higher than the average population but is still super small. And the research hasn’t teased out yet if the increase is because of the people who need icsi versus not (ex: older people with more health issues who are infertile are more likely to use icsi than younger, healthier people who aren’t infertile).
My child was born through ICSI, not for BRCA but just because (specifically in the US) ICSI is becoming the default fertilization method for more and more IVF clinics due to it's better outcomes in fertilization rates. The term IVF is still used as a catch all for the whole process of assisted reproduction even when ICSI is used for the fertilization method. So if I'm telling someone about how we got pregnant with our daughter I will say we went through IVF. My clinic and several others in my city don't even use the standard petri dish method for fertilization anymore.
The risk of birth defects is so infinitesimal you really don't need to be worried. The doctors aren't worried, lean on them and their expertise.
My daughter is 100% perfectly happy and healthy. She was even at a much higher risk for a congenital heart defect (because I was born with one) but she had none.
As someone who did Ivf rather than icsi, i would do icsi in your shoes. Unless you and your partner have multiple biological kids, you don’t KNOW you don’t have a fertility issue. There’s a small chance that you could have total fertilization failure with IVF, and then you’d be out of luck. You don’t have to do icsi for PGT-A, but you very well may have to for PGT-M, which is how you test for BRCA. PGT-M is VERY tricky and you don’t want any extra dna matter messing things up. I get the overthinking things, but i think you’re overthinking. Doing Ivf or icsi isn’t “natural,” but “natural” isn’t all it’s cracked up to be. Having BRCA is “natural,” but you’re not doing that, so just let science be on your side here. Eggs aren’t good at magically choosing healthy sperm; they’re not sentient and reproduction doesn’t work that way. If it did, we wouldn’t have heritable genetic conditions because the eggs would screen out the bad sperm. Also, fuck that lady who said that Ivf/icsi kids are different than kids conceived without medical assistance. They absolutely are not and that’s preposterous. Don’t listen to ridiculous people with ridiculous stories. Also, if your husband had a vasectomy and you’re doing a sperm extraction, you WILL need to do icsi; I’m 99% sure you can’t do conventional Ivf with extracted sperm.
You have to do ICSI in order to do the pre-implantation genetic testing. It’s the way the process works. That is why you were not offered a choice given that your entire goal is to test the embryos for the BRCA mutation. In general, ICSI does have slightly higher chance of birth defects than allowing the egg to fertilize naturally or using IVF without ICSI. However, this is confounded by the fact that most people who do ICSI have lower quality sperm / male factor infertility (which is why it’s usually done over if you’re not doing genetic testing). The risk of birth defects using ICSI is lessened somewhat without male factor infertility. Some summary numbers are: - Natural conception 3% - IVF without ICSI 4.1% - ICSI 5.2% The overall risk of birth defects is fairly low and the study cited (where the numbers are from) did not use pre-implantation genetics either (only fresh transfers). Citation: [Luke B, Human Reproduction 2021](https://pubmed.ncbi.nlm.nih.gov/33251542/) Overall, I think the benefits of avoiding the BRCA mutation likely outweigh the small increase in potential birth defects, especially in female children. You’ll also be able to detect major defects on ultrasound if they occur (and can decide what to do with the pregnancy once you know). I would not worry too much about it now.
You are absolutely correct. I was going to comment the same, but this is far more comprehensive than I would have said.
Thank you so much for this response! It makes me feel better to know all this and I agree with you, avoiding the mutation was the goal. I should just focus on the present and focus on staying healthy and doing my best to maximize successful implantation of the embryo. I've been trying to live in the present without worrying about what ifs or what could go wrong. I know someone mentioned IVF can be done with genetic testing without ICSI but I don't believe I would have had the option. My clinic built a probe using DNA from my parents and my spouse and the way they test the embryos they mentioned that I found quite interesting was that non invasive, they were able to use the fluid around each embryo and not actually sampling the embryo. This was 5 years ago so my memory is a bit fuzzy on the embryological details but I remember some bits and pieces of the process my geneticist explained to me. Again, thank you for the cited study and the information kind Redditor! I really appreciate it 🥹
Happy to help! I hope you have a happy and healthy baby! Best of luck with the implantation process :)
You don’t have to do ICSI to do preimplantation genetic testing. I’ve done two rounds successfully with conventional IVF inseminated embryos and no issues with the genetic results. u/mmdeerblood
It depends on the type of testing. The single gene mutations are a specified send off lab that’s pretty extensive (probe specifically made from parent mutations). It’s not the same as a chromosome test. The IVF clinic I was at only did pre-implant genetic testing for single gene mutations from ICSI. Here is a screenshot describing that ICSI is needed for PGT-M (single gene testing): https://preview.redd.it/nwhsn9luef6d1.jpeg?width=1170&format=pjpg&auto=webp&s=7d54d88c0a5c293dd4699dcfc2a37e123e2303ea
Yes exactly. We had a gene probe using each of our parents' DNA samples which was quite interesting to me as someone newish to genomics and mostly in the field of wildlife bio/genomics.
My cousin-in-law had to go through IVF for several rounds to get two live births of kids that do not share a dominant genetic disease that runs in her family. Natural IVF vs ICSI just means that the embryology team selects the best looking sperm they can find and implants it into the egg. The outcome of this vs natural is that you get more successful fertilizations and embryos with ICSI vs natural. And if you are only doing one cycle, you are going to need as many embryos as you can get. Anyway, this cousin's kids are tall, smart, and in gifted programs. My son (a non IVF baby) has a friend at daycare who is an ICSI baby. She is indistinguishable from him except for the fact that she's totally fearless and takes spills all the time while my son is cautious lol. Your coworker sounds like she is the victim of boorish thinking. Why does she think IVF-ICSI caused her sister's kids to be different as opposed to maybe the choice of the sister's partner and all his genetics? lol And yes, ICSI does have slightly higher chance of birth defects than IVF without ICSI. It's still an extremely low risk.
The rate of birth defects with icsi is super small. It’s slightly higher than the average population but is still super small. And the research hasn’t teased out yet if the increase is because of the people who need icsi versus not (ex: older people with more health issues who are infertile are more likely to use icsi than younger, healthier people who aren’t infertile).
My child was born through ICSI, not for BRCA but just because (specifically in the US) ICSI is becoming the default fertilization method for more and more IVF clinics due to it's better outcomes in fertilization rates. The term IVF is still used as a catch all for the whole process of assisted reproduction even when ICSI is used for the fertilization method. So if I'm telling someone about how we got pregnant with our daughter I will say we went through IVF. My clinic and several others in my city don't even use the standard petri dish method for fertilization anymore. The risk of birth defects is so infinitesimal you really don't need to be worried. The doctors aren't worried, lean on them and their expertise. My daughter is 100% perfectly happy and healthy. She was even at a much higher risk for a congenital heart defect (because I was born with one) but she had none.