Abstract
ICSI is a technique of fertilization developed to treat male infertility. However, it has become routine to use ICSI in cases of unexplained infertility, poor fertilization, and low egg number, despite the lack of clinical evidence to support its use. In fact, SART data from 2004 show that ICSI was used in 57% of ART cycles, while only 17% of ART cases carried a diagnosis of male infertility. Given recent evidence suggesting an increased risk for hypospadia and sex chromosome aneuploidies in infants born as a result of ICSI, its use and indication warrant re-evaluation. The goal of this study is to determine whether ICSI is indicated in cases of low egg number in the setting of normal semen parameters. Retrospective database review. 2522 cases were reviewed, encompassing all IVF/ICSI cycles performed at UCSF between January 2001 and March 2006. All cases where 4 or less oocytes were retrieved, and semen analysis was normal by WHO criteria, were included in analysis. Outcome measures included method of fertilization, fertilization rate, pregnancy rate (positive serum pregnancy test) and on-going pregnancy rate (fetal cardiac activity). Parametric statistics was used as indicated. 149 patients met criteria of 4 or less oocytes obtained at the time of retrieval. Of these, 48 patients, with a mean age of 39.1, underwent traditional IVF and 101, with a mean age of 38.6, had ICSI performed. Fertilization rate did not differ significantly between the groups (54.7% for IVF vs. 56.5% for ICSI, p= NS). There was also no difference in ongoing pregnancy rate between the two groups (13.3% for IVF vs. 13.0% for ICSI, p= NS). Our results suggest that ICSI is not indicated in cases of low egg number and normal semen parameters. Given the possible increased risks associated with the use of ICSI, we believe traditional IVF should be used in cases of low egg number when semen parameters are normal.
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