ICSI Does Not Improve Live Birth Rates but Yields Higher Cancellation Rates Than Conventional IVF in Unexplained Infertility.

Jianyuan Song,Jian Xu,Kaiyou Fu,Tingting Liao

doi:10.3389/fmed.2020.614118

Abstract

Objectives: Unexplained infertility has been one of the indications for utilization of intracytoplasmic sperm injection (ICSI). However, whether ICSI should be preferred to IVF for patients with unexplained infertility remains an open question. This study aims to determine if ICSI improves the clinical outcomes over conventional in vitro fertilization (IVF) in couples with unexplained infertility.Methods: This was a retrospective cohort study of 549 IVF and 241 ICSI cycles for patients with unexplained infertility at a fertility center of a university hospital from January 2016 and December 2018. The live birth rate and clinical pregnancy rate were compared between the two groups. Other outcome measures included the implantation rate, miscarriage rate, and fertilization rate.Results: The live birth rate was 35.2% (172/488) in the IVF group and 33.3% (65/195) in ICSI group, P = 0.635. The two groups also had similar clinical pregnancy rates, implantation rates, and miscarriage rates. The fertilization rate of IVF group was significantly higher than that of ICSI group (53.8 vs. 45.7%, P = 0.000, respectively). Sixty-one and 46 patients did not transfer fresh embryos in IVF and ICSI cycles, respectively. Patients with IVF cycles had lower cancellation rates than those with ICSI (11.1 vs. 19.1%, P = 0.003, respectively).Conclusion: ICSI does not improve live birth rates but yields higher cancellation rates than conventional IVF in the treatment of unexplained infertility.

Highlights

Though the technique of directly injecting a selected spermatozoon into each oocyte was introduced for male factor infertility [1], there has been an increase in the use of intracytoplasmic sperm injection (ICSI) for all populations even without male factor
This study aims to report clinical outcomes of patients with unexplained infertility, resulting from their first cycle of ICSI vs. conventional in vitro fertilization (IVF)
No statistically significant difference was found in maternal age, years of infertility, follicle stimulating hormone (FSH), antral follicle count (AFC), body mass index (BMI), or type of infertility between the two groups

Summary

Introduction

Though the technique of directly injecting a selected spermatozoon into each oocyte was introduced for male factor infertility [1], there has been an increase in the use of intracytoplasmic sperm injection (ICSI) for all populations even without male factor. Unexplained infertility has been one of the indications for utilization of ICSI. Whether ICSI should be preferred to in vitro fertilization (IVF) for patients with unexplained infertility remains an open question. Several clear end points need to be assessed if advocating the routine use of ICSI in unexplained infertility: normal fertilization rates, embryo quality, implantation rates, and live birth rates. This study aims to report clinical outcomes of patients with unexplained infertility, resulting from their first cycle of ICSI vs conventional IVF

Objectives

Methods

Results

Discussion

Conclusion