Abstract
This study compared the cumulative live birth rates following Intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilization (cIVF) in women aged 40 years or more and unexplained infertility. A cohort of 685 women undergoing either autologous conventional IVF or ICSI was retrospectively analyzed. The effects of conventional IVF or ICSI procedure on cumulative pregnancy and live birth rates were evaluated in univariate and in multivariable analysis. In order to reduce potential differences between women undergoing either IVF or ICSI and to obtain unbiased estimation of the treatment effect, propensity score was estimated. ICSI was performed in 307 couples (ICSI group), whereas cIVF was performed in 297 couples (cIVF group), resulting in 45 and 43 live deliveries, respectively. No differences were observed in morphological embryo quality, in the number of cleavage stage embryos, in the number of transferred embryos, and in the number of vitrified embryos. As for the clinical outcome, no differences were observed in pregnancy rate, cumulative pregnancy rate, live birth rate, cumulative live birth rate, and abortion rate. The present results suggest that ICSI is not associated with increased likelihood of a live birth for unexplained, non-male factor infertility, in women aged 40 years or more.
Highlights
Intracytoplasmic sperm injection (ICSI) was introduced in 1992 in order to treat infertility in couples with severe male factor [1]
ICSI was performed for 307 couples (ICSI group), whereas conventional in vitro fertilization (cIVF) was performed for 297 couples
All variables were similar between the cIVF and ICSI groups except for the years of infertility and a history of previous assisted reproductive technologies (ARTs) treatments, which were both higher in the ICSI group
Summary
Intracytoplasmic sperm injection (ICSI) was introduced in 1992 in order to treat infertility in couples with severe male factor [1]. Enough, the largest increase in ICSI application has been observed among couples without male factor infertility (from 15% in 1996 to 67% in 2012) [5]. There is no clear evidence that ICSI leads to better reproductive outcomes in non-male infertility, compared to cIVF. A previous Cochrane review of cIVF versus ICSI in couples with infertility not related to a male factor did not report differences in pregnancy rates (PR). More recent data seem to confirm that cIVF and ICSI result in similar reproductive outcomes in both non-male infertility [9] and patients with a poor response to ovarian stimulation and few oocytes retrieved [10,11]
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