Male vs Female infertility
Dear Professor Winston

This is a wonderful idea – thank you so much for your time. My question is fairly simple but I’m struggling to get anyone to answer it: do male factor infertility IVF patients generally have better odds of success than couples with female fertility issues? I can’t help thinking that ICSI effectively solves the conception issue if sperm motility and count is low. At the point of embryo transfer, surely the only challenge to overcome is implantation, which women with no fertility issues should have a decent chance at achieving. … Am I oversimplifying things? My clinic is very tight lipped on success rates and won’t personalise ours at all. Thank you, A

Dear A,

No, the reasoning isn’t quite correct. For one thing many sperm are abnormal and it can sometimes be that a sperm which looks normal down a microscope does not proceed to normal fertilisation afterwards – there may be several reasons for this, but amongst the more common is that infertile men may produce sperm which have undetectable abnormalities, for example genetic changes which cannot be easily identified. Secondly, ICSI is not a natural process and may not activate exactly the same timed sequence of events inside the egg which would accompany normal fertilisation when the sperm penetrates the egg without external help. Having said all this, if embryonic development follows normally after ICSI then the chance of pregnancy is good but not significantly better than with any form of IVF.

The other issue is that artificial injection of the egg may carry faint risks to the child a long time after birth. This risk is not well established but, for example, it turns out that studies have indicated there seems to be a slightly greater incidence of autism in children who have been born after ICSI. The risk, if it is real at all, is low but it is a very good reason for only using ICSI when it is really necessary. Another issue is that children born following ICSI, if male, may inherit a genetic cause for the infertility.

Your clinic should not be tight-lipped on success rates. You have the right to have full access to all data concerning any medical treatment if you ask, and this definitely is the case with demanding treatments like IVF. If the clinic is private then certainly not getting clear information is one good reason for considering whether you might wish to take your ‘custom’ elsewhere.

Best wishes
Robert Winston