More blastocysts are produced from fewer oocytes in ICSI\xa0 compared to IVF \u2013 results from a sibling oocytes study and definition of a new key performance indicator

Sandrine Chamayou,Carmen Ragolia,Annalisa Liprino,Michele Fichera,Clementina Cardea,Giorgia Storaci,Antonino Guglielmino,Carmelita Alecci,Simona Romano,Roberta Sapienza,Elena Maglia

doi:10.1186/s12958-021-00804-2

Abstract

BackgroundWhich fertilization method, between ICSI and IVF in split insemination treatments, has the highest clinical efficiency in producing clinically usable blastocyst?Methods211 infertile couples underwent split insemination treatments for a non-severe male factor. 1300 metaphase II (MII) oocytes were inseminated by conventional IVF and 1302 MII oocytes were micro-injected with the same partner’s semen. Embryo development until blastocyst stage on day V and clinical outcomes were valuated trough conventional key performance indicators (KPI), and new KPIs such as blastocyst rate per used MII oocytes and the number of MII oocytes to produce one clinically usable blastocyst from ICSI and IVF procedures.ResultsThe results were globally analyzed and according to ovarian stimulation protocol, infertility indication, and female age. The conventional KPI were online with the expected values from consensus references. From global results, 2.3 MII oocyte was needed to produce one clinically usable blastocyst after ICSI compared to 2.9 MII oocytes in IVF. On the same way, more blastocysts for clinical use were produced from fewer MII oocytes in ICSI compared to IVF in all sub-groups.ConclusionsIn split insemination treatments, the yield of clinically usable blastocysts was always superior in ICSI compared to IVF. The new KPI "number of needed oocytes to produce one clinically usable embryo" tests the clinical efficiency of the IVF laboratory.

Highlights

The two main in vitro fertilization techniques are conventional In Vitro Fertilization (IVF) [1] and IntraCytoplasmic Sperm Injection (ICSI) [2, 3]
Key Message In split insemination study treatments, the yield of clinically usable blastocysts is superior in ICSI compared to IVF
In vitro results A total of 2602 cumulus-oocyte complexes (COC) were retrieved from which 1302 COC were used for ICSI and 1300 for IVF

Summary

Introduction

The two main in vitro fertilization techniques are conventional In Vitro Fertilization (IVF) [1] and IntraCytoplasmic Sperm Injection (ICSI) [2, 3]. ICSI solves severe male factor [2], unexplained infertility with previous fertilization failure [5], is commonly applied in case of reduced oocyte yield [6] and when thawed oocytes are used [7]. In Italy, conventional IVF with fresh and non-donated gametes was applied in only 15.2% of the assisted fertilization treatments in 2019 [9]. Sincethe early 2000’ and in different IVF units, the split insemination strategy hasbeen applied to compare IVF and ICSI results from oocytes produced from thesame ovarian stimulation (sibling oocytes) [10, 11]. Throughthis strategy, it is possible to verify if gametes are competent to fertilize bythemselves in IVF or if they need to be assisted by ICSI. Between ICSI and IVF in split insemination treatments, has the highest clinical efficiency in producing clinically usable blastocyst?

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