OBJECTIVE: There is a growing body of evidence that ICSI should be used only in specific cases of male factor infertility. Yet it is still common belief that ICSI could give a better chance of fertilization, cleavage and general development to an embryo when compared with IVF. We set out to establish if ICSI is better than IVF in cases of poor ovarian responders (where three or less oocytes are collected) and absence of a severe male factor.DESIGN: This is an eight-year retrospective, electronic database and single chart review of all ART cycles undertaken in a tertiary referral/academic unit in Ireland.MATERIALS AND METHODS: All cycles with three or less oocytes retrieved were included in the study. This population (n=419) was divided according to the laboratory procedure performed (IVF: Group 1 or ICSI: Group 2). In the ICSI group we identified a sub-group of patients who had ICSI as per consent but based on their semen analysis on the day of oocyte collection would have fulfilled our criteria for IVF (Group 3). We compared Group 1 and Group 3 according to the following parameters: transfer, fertilization and cleavage rates; positive pregnancy test, number of pregnancy sacs and fetal hearts per cycle started.RESULTS: In the study groups (n=337), fertilization (65.8% vs. 67.5%) and cleavage rates (89.4% vs. 85.1%) were comparable. The transfer rate and mean number of embryos transferred were also similar, (70.2% vs. 71.0%) and (1.55 vs. 1.6) respectively. No significant differences were present in both implantation rates (p=0.18) and clinical pregnancy rates per cycle started (p=0.26), when comparing Group 1 with Group 3 (12.8% vs. 7.2% and 11.3% vs. 6.5%, respectively).CONCLUSIONS: This study shows that in the absence of a severe male factor and in the context of poor ovarian response (3 or less oocytes collected), ICSI does not offer a better chance of pregnancy. While not statistically significant, clinical pregnancy rates per transfer were nearly double in Group 1 when compared with Group 3 (16.1% vs. 9.1%). This demonstrates that IVF should be the procedure of choice rather than ICSI in this highly selected group of patients. Our findings suggest that a prospective randomized trail should be performed to further assess these results. OBJECTIVE: There is a growing body of evidence that ICSI should be used only in specific cases of male factor infertility. Yet it is still common belief that ICSI could give a better chance of fertilization, cleavage and general development to an embryo when compared with IVF. We set out to establish if ICSI is better than IVF in cases of poor ovarian responders (where three or less oocytes are collected) and absence of a severe male factor. DESIGN: This is an eight-year retrospective, electronic database and single chart review of all ART cycles undertaken in a tertiary referral/academic unit in Ireland. MATERIALS AND METHODS: All cycles with three or less oocytes retrieved were included in the study. This population (n=419) was divided according to the laboratory procedure performed (IVF: Group 1 or ICSI: Group 2). In the ICSI group we identified a sub-group of patients who had ICSI as per consent but based on their semen analysis on the day of oocyte collection would have fulfilled our criteria for IVF (Group 3). We compared Group 1 and Group 3 according to the following parameters: transfer, fertilization and cleavage rates; positive pregnancy test, number of pregnancy sacs and fetal hearts per cycle started. RESULTS: In the study groups (n=337), fertilization (65.8% vs. 67.5%) and cleavage rates (89.4% vs. 85.1%) were comparable. The transfer rate and mean number of embryos transferred were also similar, (70.2% vs. 71.0%) and (1.55 vs. 1.6) respectively. No significant differences were present in both implantation rates (p=0.18) and clinical pregnancy rates per cycle started (p=0.26), when comparing Group 1 with Group 3 (12.8% vs. 7.2% and 11.3% vs. 6.5%, respectively). CONCLUSIONS: This study shows that in the absence of a severe male factor and in the context of poor ovarian response (3 or less oocytes collected), ICSI does not offer a better chance of pregnancy. While not statistically significant, clinical pregnancy rates per transfer were nearly double in Group 1 when compared with Group 3 (16.1% vs. 9.1%). This demonstrates that IVF should be the procedure of choice rather than ICSI in this highly selected group of patients. Our findings suggest that a prospective randomized trail should be performed to further assess these results.