Is ICSI superior to conventional IVF in severe male factor: a 3 year prospective observational study

Abstract

To study whether IVF (in-vitro fertilisation) yields better outcome in severe male factor infertility over Intracytoplasmic sperm injection (ICSI) in terms of live-birth ,obstetric outcome and congenital anomalies. This prospective observational study included 253 women whose male partner had TMC (Total motile count) <1million and underwent conventional IVF or ICSI from January 2014 to December 2016. All subjects were between 25-37 years. Records of prenatal care of mother and neonates were reviewed. Developmental wellbeing of children born after IVF/ICSI were followed for three years. The 253 male partners who had semen analysis on day of oocyte retrieval with <1million motile sperm and morphology>4% after wash, were included and divided into Group A (GrA) (n=121) in which conventional insemination was done and Group B (GrB)(n=132) where ejaculated ICSI was done. Antagonist protocol was performed. Total fertilization failure were 6/121(4.9%) in GrA and 3/132(2.2%) in GrB. Rest 244 patients with 295 cycles were analysed. Other female factors-PCOS, endometriosis, tubal factors and uterine defects were excluded. Both groups were comparable in terms of age of both partners, BMI, dose of gonadotropins, estradiol on day of oocyte retrieval, endometrial thickness and number of oocytes retrieved. Conventional IVF group (496/840, 59.01%) had significantly lower fertilization rate than ejaculated ICSI (591/910, 64.94% p=0.0119). although number of day 3 embryos were comparable in both groups (GrA 407/496, 82.05% vs GrB 467/591,79.01%). Pregnancy rate per embryo transfer in GrA was 42.2% and GrB was 47.61% (p=ns). Pregnancy per oocyte retrieval was also comparable-38.58% in conventional IVF and 42.85% in ICSI. Live birth rate per oocyte retrieval was also similar in both groups (GrA 30.6% vs GrB 26.4%). Missed abortion, though higher in ICSI group was not significantly different than conventional IVF (GrA 26.53% vs GrB 29.1%). Antenatally two patients in ICSI group had pre-eclamptic toxaemia (PET) while none had the condition in IVF group. One baby in ICSI group was terminated due to chromosomal defect and two babies born after ICSI had birth defects (one hypospadius and the other imperforate anus). In IVF group one baby had posterior urethral valve. Incidence of PET and congenital anomalies could be chance findings in this study. In our study conventional IVF is as good as ejaculated ICSI in terms of reproductive outcome, where male partner had <1million motile sperm in post wash sample. IVF could be the first choice over ICSI in severe male factor infertility especially in developing countries which will decrease the cost of ART.