Is it time to choose IVF or ICSI?


That may be a question running in your head when you have been trying to conceive for a while, and you may be feeling a little unsure — even a little anxious or frustrated.


You have started thinking that assisted reproductive therapies (ART) may be an option for you such as having an IVF cycle attempt or ICSI procedure. You are just not sure when to actually start pursuing them.


It is crucial that you understand your options, especially in some specific situations, and learn the strategy changes required to help get you the ultimate outcome you want — the healthy baby of your dreams.

The beginning of your fertility journey

On your fertility journey, the very first step is maximizing every other option there is for natural conception before turning to ART. 


After exhausting all options and you are left with IVF or ICSI, there are still things you and your partner must do before embarking on these for increasing your chances at success.


Preparing your bodies to gain optimum health and fertility is hitting two birds with one stone — you may be surprised that you just need to tap a little more onto your natural fertility, or you can have the wonderful news of your ART procedure being successful.


This preparation must be done for the minimum time of at least 120 days that it take for the egg to mature and the sperm to form in the best possible environment — ensuring best results.[1-9]

When to consider ART options?

Once you have completed your preparation, you will know it is time to really opt for ART when:

1. After optimising your health and fertility, you have tried to conceive naturally for over 12 months

Let us say you have completed a comprehensive preconception healthcare program and maintained the essential lifestyle changes to continue enhancing your natural fertility. This is whilst timing conception appropriately. However, if you have not had a conception in 12 months — then ART may be the next step for you.[10]


It is important to note that your healthcare program should both be diagnostic and therapeutic. It is vital that throughout its duration, you (on the advice of your practitioner) actively seek out more information (through specialised assessment and/or testing) about areas of your health that perhaps may need to be addressed in order to improve your odds of creating a healthy baby. 


Once you find this information, the next step is to be proactive in making positive changes.[11]

2. You or your partner have been diagnosed with azoospermia

Despite the possible small amount of specific improvement that preconception preparation can make to men that produce very little to no sperm — the change is unlikely to be enough to help bring forth a natural conception. 


But in some cases, you can produce a few motile sperm and have a chance of conception through an ICSI procedure. In this situation, the only other options include donor sperm or donor embryo transfer.[12-14]

3. You have completely blocked fallopian tubes

In this situation, the best thing to do is complete your preconception preparation and go straight to IVF because if both of your tubes are 100% blocked, it is highly unlikely a natural conception will ensue. 


And just as previously mentioned, prior preparation can improve your odds of taking home a healthy baby when your body is in optimum health before an IVF cycle attempt.[15]

4. You have been diagnosed with ovarian failure or premature menopause

In these cases, you may still be able to get pregnant and have a healthy baby. However, you may need to use either a donor egg or donor embryo. Both options are available in most parts of the world and, of course, are forms of ART.[16,17]


When choosing a donor egg or embryo, also boost your health beforehand for best results.

5. If you are over 43, have completed 120 days of preconception preparation, and subsequently had 6 conception attempts without luck

For some couples, this may be another cue to seek ART because as a woman’s ovarian reserve declines, so do the chances of making it happen through IVF.


Some IVF clinics may also refuse giving treatment to a woman over 45 if she plans to use her own eggs due to diminished chances at success.[18]

Final thoughts

The IFV or ICSI success rate is promising. When after deliberate preparation and consultation you decide the best for you is to undergo any of these procedures, implement ways that will optimize your health for the best possible outcome.


If you would like to discuss how our Fertility Breakthrough Program™ can support you to enhance your fertility, you can have a COMPLIMENTARY consultation with Fertility Specialist Gabriela Rosa. Schedule your appointment HERE.



[1] Purewal, S., et al. A systematic review and meta-analysis of psychological predictors of successful assisted reproductive technologies. BMC Research Notes, 2017. 10. PMID: 29212545.

[2] Rossi, B.V., et al. Effect of Alcohol Consumption on In Vitro Fertilization. Obstetrics and Gynecology, 2011. 117(1). PMID: 21173655.

[3] Firns, S., et al. The effect of cigarette smoking, alcohol consumption and fruit and vegetable consumption on IVF outcomes: a review and presentation of original data. Reproductive Biology and Endocrinology, 2015. PMID: 26669322.

[4] Gaskins, A.J., et al. Dietary Folate and Reproductive Success Among Women Undergoing Assisted Reproduction. Obstetrics and Gynecology, 2014. 124(4). PMID: 25198264.

[5] Karayiannis, D., et al. Adherence to the Mediterranean Diet and IVF Success Rate Among Non-Obese Women Attempting Fertility. Human Reproduction, 2018. 33(3). PMID: 29390148.

[6] Afeiche, M.C., et al. Processed Meat Intake Is Unfavorably and Fish Intake Favorably Associated With Semen Quality Indicators Among Men Attending a Fertility Clinic. Journal of Nutrition, 2014. 144(7). PMID: 24850626.

[7] Hipwell, A.E., et al. Exposure to non-persistent chemicals in consumer products and fecundability: a systematic review. Human Reproduction Update, 2019. 25(1). PMID: 30307509.

[8] Dupont, C., et al. Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial – the PEPCI study. BMC Pregnancy and Childbirth, 2020. 20. PMID: 32456614.

[9] Arhin, S.K., et al. Effect of micronutrient supplementation on IVF outcomes: a systematic review of the literature. Reproductive Biomedicine Online, 2017. 35(6). PMID: 28919239.

[10] Stern, K., et al. Assisted Reproductive Technology – What’s New and What’s Important? Australian Family Physician, 2012. 41(10). PMID: 23210097.

[11] Bashiri, A., et al. Recurrent Implantation Failure-update overview on etiology, diagnosis, treatment and future directions. Reproductive Biology and Endocrinology, 2018. 16(1). PMID: 30518389.

[12] Westlander, G. Utility of micro-TESE in the Most Severe Cases of Non-Obstructive Azoospermia. Upsala Journal of Medical Sciences, 2020. 125(2). PMID: 32233715.

[13] Hennebicq, S., et al. Donor Sperm Insemination After Failed Intra-Couple Intracytoplasmic Sperm Injection. Systems Biology in Reproductive Medicine, 2018. 64(2). PMID: 29020465.

[14] Yu, Y., et al. Pregnancy and Neonatal Outcomes in Azoospermic Men After Intracytoplasmic Sperm Injection Using Testicular Sperm and Donor Sperm. Medical Science Monitor, 2018. PMID: 30270922.

[15] Volodarsky-Perel, A., et al. Treatment of Hydrosalpinx in Relation to IVF Outcome: A Systematic Review and Meta-Analysis. Reproductive Biomedicine Online, 2019. 39(3). PMID: 31324437.

[16] Chae-Kim, J.J., et al. Premature Ovarian Insufficiency: Procreative Management and Preventive Strategies. Biomedicines, 2019. 7(1). PMID: 30597834.

[17] Męczekalski, B., et al. Reproduction in premature ovarian insufficiency patients – from latest studies to therapeutic approach. Menopause Review, 2018. 17(3). PMID: 30356967.

[18] Warshaviak, M., et al. The Effect of Advanced Maternal Age on Embryo Morphokinetics. Frontiers in Endocrinology, 2019. PMID: 31708867.