Abstract
Following earlier studies introducing an IVF-ICSI Split model on couples with unexplained infertility to avoid the scenario of unexplained failed or poor fertilization, PIVET has adopted a high ICSI rate approaching 90%, whereas the general rate among Australian facilities is around 60%. This observational study with retrospective data analysis reports on the IVF±ICSI procedures conducted over the period 2011 to 2019 with follow-up of ensuing pregnancies through 2020. Using autologous oocytes, 2343 women had 3434 IVF±ICSI cycles where 84.5% of women had 88.9% of initiated treatment cycles using ICSI and only 5.3% of women had 4.0% of cycles by IVF. The remaining 10.1% of women utilized the IVF-ICSI Split model for the remaining 7.2% of cycles. It was shown that oocyte fertilization rates were significantly higher for ICSI (p<0.0001), but not significant for women >40 years. The utilization rates of the ensuing embryos were ~45% across all ages with no significant differences across the ages, except for those small numbers of women ≥45 years who had a higher rate from IVF-generated embryos (p<0.0002). Pregnancy outcome were higher from ICSI-generated embryos across the age groups, being especially marked among the younger women <40 years (p<0.0001). Miscarriage rates were lowest for the IVF-generated pregnancies (overall 6.7% vs 22.8%, p<0.0001) but nevertheless the final live birth productivity rates per initiated treatment cycle remained higher from the ICSI-generated pregnancies (56.5% vs 46.3%; p<0.0001). Although this study does not meet the highest standards for EBM, it emanates from a pioneer facility with >40 years of published activity and which practices 90% blastocyst transfers in >90% SET cycles. The study supports a high ICSI rate of almost 90% and an IVF-ICSI Split rate of 10%.
Highlights
The technique of in vitro fertilization (IVF) commenced in the United Kingdom as an activity supported under the national health service (NHS), thereafter moving into private practice facilities from 1980 [1,2]
Miscarriage rates were lowest for the IVF-generated pregnancies but the final live birth productivity rates per initiated treatment cycle remained higher from the ICSIgenerated pregnancies (56.5% vs 46.3%; p
The findings in our study provides some mixed messages, but overall supports PIVET’s approach that an overall intra-cytoplasmic sperm injection (ICSI) rate of ~85% which includes a number of non-male factor scenarios, optimises the clinical outcomes for IVF management and results in more live babies arising from the overall IVF program
Summary
The technique of in vitro fertilization (IVF) commenced in the United Kingdom as an activity supported under the national health service (NHS), thereafter moving into private practice facilities from 1980 [1,2]. With respect to male factor infertility, the early IVF methodology was seen to have limited success [8, 9, 10, 11] a number of laboratory-based methods were applied. These included specialized sperm preparations [12], pentoxifylline enhancement of both sperm motility and function [13,14], and micromanipulation methods such as partial zona dissection (PZD) and sub-zonal insemination (SUZI) [15], culminating in the highly effective intra-cytoplasmic sperm injection (ICSI) technique, reported in 1992 [16]. Albeit as a controversial progression, ICSI has been applied to non-male factors including unexplained infertility, followed by “precious” scenarios such as older women with few oocytes in order to avoid the risk of failed fertilization (18)
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