DOES INTRACYTOPLASMIC SPERM INJECTION (ICSI) PROVIDE ANY BENEFIT OVER IN VITRO FERTILIZATION (IVF) ON PREGNANCY OUTCOMES IN NON-MALE FACTOR INFERTILITY CYCLES UNDERGOING PRE-IMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A)?

Abstract

ICSI is currently the recommended fertilization method for cycles undergoing PGT-A 1. To our knowledge there are no studies evaluating pregnancy outcomes of PGT-A transferred embryos inseminated by IVF versus ICSI. Our objective is to evaluate whether significant differences exist in pregnancy outcomes from PGT-A transferred embryos fertilized by IVF compared to ICSI. Retrospective cohort study at a single academic institution. All frozen embryo transfers (FET) performed from 1/2016 to 2/2020 that underwent PGT-A from trophectoderm biopsy and tested by next generation sequencing were evaluated. Exclusion criteria included diagnosis of male factor infertility, embryos tested for pre-implantation genetic testing for monogenic disorders, structural rearrangements, or HLA-typing, cryopreserved oocytes, blastomere or polar body biopsy, in vitro maturation, rescue ICSI, and split IVF/ICSI cycles. Patient demographics, infertility diagnoses, cycle characteristics, and pregnancy outcomes including not pregnant, biochemical pregnancy, miscarriage, ongoing pregnancy (OP), and live birth (LB) were collected. Primary outcome was OP/LB rates. Secondary outcomes included miscarriage and biochemical rates. Chi-square or Fisher’s exact test, as appropriate, and Mann-Whiney test were used for categorical and continuous variables, respectively. Outcomes between both groups were compared using a repeated-measures mixed-effects logistic regression model, in which the rates were adjusted for confounding variables attained during the univariate screen. Results were considered statistically significant with a p-value <0.05. A total of 317 FET’s met criteria (IVF-150 [47.3%]; ICSI-167 [52.7%]). Significant difference between the IVF and ICSI cohort existed in age (35.8 y/o vs. 36.8 y/o, respectively, p=0.03), BMI (23.6 vs 25.1, respectively, p=0.005), and ethnicities. LB/OP rates and miscarriage/biochemical rates demonstrated no significant differences in IVF vs. ICSI inseminated groups (Table 1). There were no significant differences in pregnancy outcomes in FET’s between IVF and ICSI inseminated embryos that underwent PGT-A. The use of ICSI in non-male factor infertility cycles undergoing PGT-A does not provide an advantage for LB/OP rates over IVF.Table 1IVF (150)ICSI (167)p-valueNot pregnant35.7%37.3%0.79Biochemical12.1%14.8%0.62Miscarriage11.4%7.8%0.43Live birth37.3%35.0%0.69Biochemical/Miscarriage23.6%22.5%0.85Live birth/Ongoing39.8%38.3%0.74 Open table in a new tab