ICSI (Intra-Cytoplasmic Sperm Injection):
When there is male factor (severe oligo-asthnozospermia) responsible for infertility, ICSI is the option for those patients. Here under inverted microscope a single ovum is fertilized with single non-motile sperm & resultant embryo is transferred to uterine cavity.

Cycle Cancellation
Criteria for cancellation are very objective

1. The stimulation must result in a minimum of 3 mature (or close to mature) follicles (we consider follicles to be mature if they are 16-20mm in average diameter on the day of HCG).
2. Alternatively, if there are 2 follicles 16-20mm and at least 2 more that are 13-15mm, we can proceed to the egg retrieval.

There is only 1 reason that we cancel IVF stimulations for poor response: Delivery rates from IVF cycles when there are less than 3 mature size follicles present on ultrasound are much lower than with at least 3-4 follicles. We consider this to be the best "break-point" for deciding whether to proceed with egg retrieval - or cancel the cycle. This is considering that; 1. The IVF process does have some medical risks involved, and, 2. There is an additional economic cost of proceeding with the egg retrieval, fertilization, embryo culture, etc.

Unfortunately, when only a few follicles develop in response to the ovarian stimulation, there is a problem with egg quantity and (sometimes also with egg quality). In other words, we get fewer eggs and they are sometimes also of lower quality as compared to the eggs obtained from women that respond normally to the ovarian stimulation.

Prediction of probability of cancellation before starting the cycle

We can predict the ability of the woman's ovaries to respond adequately to ovarian stimulation with 2 simple and inexpensive tests. Antral follicle counts on ultrasound and day 3 FSH and clomiphene challenge test.

There are other general indicators of the risk of cancellation such as previous response to injectable gonadotropin stimulation, and female age.

Occasionally, we also need to cancel an IVF cycle because of over stimulation. In these (rare) cases the ovaries are making too many follicles and too much estrogen. There can be significant health risks (OHSS) for the woman if the HCG injection is given and the cycle completed when the ovarian response to stimulation is too high.