ICSI, Egg Health & Empowered Choices: What An Independent Embryologist Wants 40+ Women To Know
Valuable pearls of impartial wisdom from UK-based Victoria Wigley, founder of All About Embryology.
Instagram: solofertility40s
When you’re a solo woman navigating IVF in your 40s, you become the researcher, decision-maker, advocate and patient - all at once.
One decision might be whether to opt for Intracytoplasmic Sperm Injection (ICSI). In this process, a skilled embryologist injects a single sperm into the egg to maximise the chance of fertilisation occurring.
In Europe, it is offered as standard in many clinics. It was used during both my IVF cycles in Spain and Greece.
While all UK clinics offer ICSI, only around 50-60% of patients are actually recommended ICSI, typically for instances of male factor. According to the HFEA, "There is currently no scientific evidence to support the use of ICSI for cases of infertility which is not related to issues with the male partner's sperm."
So if you’re single and using top-quality donor sperm, ICSI might be less relevant.
For women over 40, there’s an added layer of potential complication: older eggs, higher risks of aneuploidy, and the fragile hope that science can bridge the biological gap. Since abnormalities in egg morphology increase with maternal age, ICSI poses more risk to these fragile eggs.
So how to make decisions when the stakes feel sky-high, the science is complicated; and overall, you feel far outside your comfort zone?
If treatment add-ons like ICSI feel like another gamble within an already precarious lottery - I know how you feel. Overwhelmed with everything, I deferred to the expertise of the medical team in both my IVF cycles. To ICSI, or not, wasn’t ever discussed as an option.
(Now armed with more facts, I’ll play a more active role in future.)
So I was relieved to stumble on Victoria’s Instagram channel - All About Embryology. As an independent embryologist, Victoria offers impartial advice and isn't affiliated with any clinic. Clients benefit from her considerable 17 years of clinical expertise.
I needed to understand more about what actually happens in the lab to my precious eggs (and donor sperm). Even after two (failed) IVF cycles, the nuts and bolts of what goes on “back there” is still largely a mystery.
Yet I've a sense that these lab people are the true heroes of the process. The experts working with the microscopic building blocks of life. The steady hands and minds keeping it all together.
Victoria comments:
“I work directly with my patients to review any previous laboratory results, explain treatment options, and bring much-needed transparency to a deeply opaque system. Then my clients can make more informed choices.“
Her patients typically want to know:
What treatment add-ons they really need;
Which treatment types are most appropriate for them;
What questions to ask their doctor in a follow-up appointment before their next cycle, especially addressing any areas that need attention for a future cycle;
What to do in advance of a cycle to improve egg and sperm quality;
Their expected outcomes, such as average fertilisation rates, blastocyst rates etc.
“I love empowering my patients with the knowledge they need to make their journey a little easier. Also, so they can advocate for themselves when they’re have to give informed consent for procedures.“
When Does ICSI Make Sense?
It’s most often used when:
Sperm parameters are poor;
When there is known high DNA fragmentation levels in the sperm;
When frozen eggs are being used;
Previous cycles showed low fertilisation rates.
Solo women tend to use top-quality donor sperm. However, if the sperm does not survive the thaw process, ICSI may be an important add-on for these women.
Victoria explains:
"ICSI is appropriate for poor sperm parameters, or when using frozen eggs. PICSI or IMSI both use a more specific method of sperm selection for ICSI, and is sometimes offered when there’s known high DNA fragmentation or there has been low fertilisation, even with ICSI. But not every patient needs it and there will always be additional costs involved above standard ICSI."
In fact, even using standard ICSI when it's not needed will add unnecessary cost. Or worse, potentially cause damage to your eggs during the injection process; a process that already has so many variables. It’s always worth clarifying whether ICSI is being recommended based on evidence, or as standard.
If you are unsure about ICSI, ask for your clinic’s fertilisation KPIs (key performance indicators) to help you assess the lab’s performance. The baseline levels to look for are above a 60% fertilisation rate, and below 10% degeneration rate.
So if your biggest challenge is egg quality, and you're using donor sperm, is ICSI necessary?
Victoria advises:
"I would always assess on a case by case basis.
If the donor sperm thaws well and the patient has no history of poor fertilisation with IVF, then I will often recommend IVF initially - without ICSI - because this is less invasive. Immature eggs have the chance to mature overnight and may still become fertilised. It allows for greater natural selection between the sperm, and is far less costly."
The Truth About Older Eggs
If you’ve seen ‘That Graph’ - the one that shows euploid (chromosomally normal) embryos plummeting with age - you’ll know the anxiety it can spark.
But Victoria is quick to reframe it.
"Yes, aneuploidy increases with age. Yes, miscarriage risk rises. But women over 40 do still get pregnant. Sometimes it’s a numbers game. Sometimes it’s about optimising the environment for eggs to develop. It’s not game over. We can’t change biology, but we can support it."
This could include:
Taking key supplements (as directed by a nutritionist)
Maintaining a healthy weight and regular moderate exercise
Reducing stress levels (where possible)
Considering DHEA supplementation to support oestrogen production and boost ovarian response (as directed by your doctor)
Choosing Your Clinic - And Protecting Your Chances
Clinics vary widely in transparency and ethics. Victoria has a front row seat in this and often sees women over 40 being pushed into:
PGT-A (a genetic test) with only 1–2 embryos, which could do more harm than good;
Egg banking, even when success rates for older eggs are not clearly explained;
Repeat cycles with poor outcomes and no updated strategy or protocol.
So what can you do?
Ask for ICSI success rates across the ages groups, degeneration rates, and embryo utilisation rates;
In frozen cycles, ask about blastocyst survival rates;
Enquire about the use of time-lapse incubators. They mimic in-utero conditions and can help identify any abnormal patterns of development in the embryos which may help non-invasively select the best embryos for transfer;
Don’t be afraid to challenge the protocol - or the add-ons.
"Know your options, arm yourself with information, and advocate for yourself. Don’t be afraid to ask hard questions."
Automation in the Lab: Progress or Pressure?
A recent story in Men’s Journal revealed the rise of automated ICSI and embryo handling - machines replacing embryologists in key parts of the IVF process.
Companies like AutoICSI claim to increase efficiency and reduce error.
For women already feeling detached or overwhelmed by the artificiality of Assisted Reproduction Technologies, automation may intensify that sense of distance. Especially for solo women who may already feel alone.
When a robot handles your egg and the donor’s sperm, how far removed from the interaction of life beginning in utero is it wise to get?
Victoria comments:
"Any advancement in technology can be very exciting, but it is important to be sceptical initially. There have been attempts before with automating processes in the lab. It didn’t take off. However the use of AI in time lapse monitoring is showing positive potential."
What Matters Most
For solo women over 40, fertility treatment isn’t just a medical process. It’s layered with grief, hope, logistics, and cost.
And too often, it happens in silence.
The emotional and decision-making burden of IVF - especially for solo women over 40 - is often carried quietly and alone.
“It’s not so much that women don’t ask enough questions, rather they’re not always given detailed insights, or the space to explore options. That's where I support, so that women are not navigating difficult decisions alone, in what is already such an emotionally challenging process.”
Compounding this silence is the taboo that still exists in many countries and communities about motherhood over 40, and solo motherhood. Some women may also feel isolated, when surrounded by women on more conventional paths to motherhood.
Victoria’s Advice?
"Be realistic, but not resigned. Understand the risks. Protect your emotional wellbeing but also don’t give up hope. Make sure you look after yourself during the process and reach out for support when you need it. Always consider: Is this recommendation right for me, or being offered as standard?"
ICSI is one tool. Technology is advancing. Your power lies in knowledge, in asking better questions, and in finding the right support.
Ideally, a professional who treats you and your embryos not as data points, but as unique and sacred individuals pursuing the magic of creating new life.
To inquire about independent advice for your next cycle, message Victoria here.
FREE: Resources page on Solo Fertility 40s with my favourite webinars, articles, forums and podcasts.
FREE: 10 Important Questions for Your Fertility Consultation (download)
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