Comparison of intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IVF in patients with non-male factor infertility.

Abstract

Objective: Although ICSI was initially utilized to treat male factor infertility, its use has become increasingly popular by assisted reproductive technology (ART) laboratories as a basic method of oocyte fertilization in patients with normal semen parameters. Some authors have demonstrated benefit to ICSI in unexplained female infertility. Many patients are also requesting ICSI to increase the chances of fertilization despite no male factor. Problems leading to fertilization failure that may occur during conventional IVF can be circumvented by ICSI. Lack of fertilization may be due to oocyte immaturity at the time of insemination, which would go undetected with conventional insemination. The purpose of this study was to evaluate the effectiveness of ICSI vs. conventional IVF in couples with non-male factor infertility. Design: A retrospective study in a private ART center. Materials/Methods: All fresh, non-donor and non-male factor IVF cycles performed from March 1999 through December 2000 (n = 311) were included in this study. Male infertility was ruled out on the day of IVF according to the WHO criteria based on concentration, count, motility and progressive movement. Following random selection, conventional IVF or ICSI was applied and embryos were cultured in G1.2 medium to day 3. Embryo transfer (ET) was performed on day 3 or embryos selected for extended culture were placed in G2.2 medium to day 5 and subsequently transferred. All micromanipulations and conventional inseminations were distributed evenly among two embryologists and the same physician performed all ET. Results: See table below. legendlegendP value = NS for all analyzed variables (significant: p < 0.05).nAge (±SD)No. oocytes (±SD)Fertilization rate (%)ICSI15934.1 ± (4.2)14.2 (7.5)73.2IVF15234.1 ± (4.2)13.9 (8.2)67.9nFailed fert.No. embr./ET (±SD)Clinical preg. (%)ICSI15913.8 (1.7)61 (38.3)IVF15253.5 (1.6)62 (40.1)legend P value = NS for all analyzed variables (significant: p < 0.05). Open table in a new tab Conclusions: Although ICSI provided no improvement to fertilization or clinical pregnancy rates in our study, it reduced fertilization failure and had no detrimental effect. This method may be considered as effective as conventional IVF when applied to those patients with non-male factor infertility and may be utilized on a routine basis for oocyte fertilization in this patient population.