Abstract
Intracytoplasmic sperm injection (ICSI) was originally designed to overcome barriers due to male factor infertility. However, a surveillance study found that ICSI use in non-male factor infertility increased from 15.4% to 66.9% between 1996 and 2012. Numerous studies have investigated fertilization rate, total fertilization failure, and live birth rate per cycle (LBR), comparing the use of ICSI versus conventional in vitro fertilization (IVF) for non-male factor infertility. The overwhelming conclusion shows no increase in fertilization rate or LBR per cycle with the use of ICSI for non-male factor infertility. The overuse of ICSI is likely related to the desire to avoid a higher rate of total fertilization failure in IVF. However, data supporting the benefit of using ICSI for non-male factor infertility is lacking, and 33 couples would need to be treated with ICSI unnecessarily to avoid one case of total fertilization failure. Such practice increases the cost to the patient, increases the burden on embryologist’s time, and is a misapplication of resources. Additionally, there remains conflicting data regarding the safety of offspring conceived by ICSI and potential damage to the oocyte. Thus, the use of ICSI should be limited to those with male factor infertility or a history of total fertilization factor infertility due to uncertainties of potential adverse impact and lack of proven benefit in non-male factor infertility.
Highlights
The emergence of intracytoplasmic sperm injection (ICSI) in the early 1990s, just a few years after the advent of in vitro fertilization (IVF), transformed the treatment of male infertility
The primary outcomes of this review were to determine if the use of ICSI for non-male factor infertility (NMF) improved reproductive outcomes, live birth rate (LBR), fertilization rate (FR), and total fertilization failure (TFF)
The use of ICSI has been proposed as a universal protocol in some clinics, while other clinics are more selective in utilizing ICSI in certain subgroups of infertility other than male factor infertility (MF) or TFF
Summary
The emergence of intracytoplasmic sperm injection (ICSI) in the early 1990s, just a few years after the advent of in vitro fertilization (IVF), transformed the treatment of male infertility. Following the introduction of ICSI, a study analyzed fertilization rates (FR) and pregnancy rates (PR) in individuals with severe MF or history of multiple TFF while stratifying by the severity of MF and sperm source [1]. They noted a drastic improvement in PR in the 227 couples within the study that was not altered by sperm source or concentration. Over half of these couples had previously experienced a TFF, but with ICSI, the average FR was 63.9%, and only two couples (approximately 0.9%) had TFF [1]. Prior to utilizing ICSI, it is important for clinicians to understand the data behind the use of ICSI for NMF, potential harm to offspring, cost burden to patient and laboratory time, as well as potential harm to oocytes or embryos
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