Comparing reproductive outcomes between conventional in vitro fertilization and nonindicated intracytoplasmic sperm injection in autologous embryo transfer cycles: a Society for Assisted Reproductive Technology Clinic Outcome Reporting System Study

Abstract

ObjectiveTo compare clinical outcomes between non-indicated ICSI and conventional insemination. DesignAutologous cycles performed at SART member clinics from 2014-2017 were identified, excluding frozen oocyte cycles. Outcomes conventional insemination (IVF) or non-indicated ICSI were analyzed separately for fresh, frozen-thawed pre-implantation genetic testing (PGT) and frozen-thawed non-PGT cycles. Subjects187,520 patients underwent 318,930 cycles, 57,516 (18.0%) using conventional IVF and 261,414 ICSI (82.0%). ExposureICSI, with or without indications [male factor, prior fertilization failure or any PGT (2012 recommendations)/single-gene PGT (2020 recommendations)]. Main Outcome MeasuresOdds ratios (ORs) for live birth rates and clinical pregnancy rates were calculated after multivariable adjustment for maternal age, BMI, infertility etiologies, prior IVF births and number oocytes retrieved. ResultsICSI was indicated in 151,627 (58.0%) of cycles according to 2012 ASRM Practice Committee recommendations, and 108,895 (41.7%) according to 2020 recommendations.In multivariable models, non-indicated ICSI among fresh cycles was associated with reduced odds of completing a blastocyst-stage transfer (OR 0.72, 95% CI (0.7, 0.75), p<0.001), resulting in reduced odds of live birth (OR 0.80, 95% CI (0.78,0.83), p<0.001). Among completed fresh transfers, clinical pregnancy and live birth rates were comparable between non-indicated ICSI and IVF.Non-indicated ICSI in frozen-thawed cycles with PGT and without PGT was associated with comparable live birth and clinical pregnancy rates to IVF in multivariable models. ConclusionNon-indicated ICSI was associated with reduced blastocyst availability in fresh cycles compared with IVF, leading to lower live birth rates. Outcomes from completed transfers were clinically comparable.