Use and outcomes of intracytoplasmic sperm injection for non-male factor infertility

Harvard University, Cambridge, Massachusetts, United States
Fertility and sterility (Impact Factor: 4.59). 10/2007; 88(3):622-8. DOI: 10.1016/j.fertnstert.2006.12.013
Source: PubMed


To determine whether intracytoplasmic sperm injection (ICSI) is associated with improved outcomes for non-male factor infertility.
We examined the patient characteristics associated with treatment choice-ICSI and conventional in vitro fertilization (IVF)-among patients without a diagnosis of male factor infertility and compared outcomes between the two groups, adjusting for patient characteristics using multivariate regression models.
Academic fertility center.
We evaluated 696 consecutive assisted reproductive technology (ART) cycles performed for couples with normal semen analysis at the Stanford Reproductive Endocrinology and Infertility Center between 2002 and 2003. We compared patient characteristics, cycle details, and outcomes for ICSI and IVF.
Fertilization, pregnancy, and live birth rates.
Patient characteristics were similar between the two groups, except the proportion of patients with unexplained infertility (IVF 15.1% vs. ICSI 23.5%), previous fertility (IVF 62.6% vs. ICSI 45.5%), and previous ART cycle (IVF 41.2% vs. ICSI 67.7%). More oocytes were fertilized per cycle for the IVF group (6.6 oocytes versus 5.1 oocytes). Fertilization failure, pregnancy, and live birth rates did not differ between IVF and ICSI. Using logistic regressions, having had previous ART was found to be positively associated with ICSI. Treatment choice of ICSI was not associated with fertilization, pregnancy, or live birth rates.
No clear evidence of improved outcomes with ICSI was demonstrated for non-male factor infertility.

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    • "These differences might have risen from the study subjects evaluated; in the study by Kim et al., the subjects were couples with non-male factors [11], whereas in our study, the subjects had a particular concern about fertilization failure. We and others [9] [11] consistently observed that clinical outcomes such as clinical pregnancy or implantation rate were lower in the ICSI group than conventional insemination group. One possible explanation for this finding might be the characteristics of female patients undergoing ICSI. "
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    ABSTRACT: Objective To determine whether intracytoplasmic sperm injection (ICSI) could prevent total fertilization failure (TFF) and enhance the embryo quality in patients with non-male factor infertility. Study Design Two hundred and ninety-six in vitro fertilization (IVF) cycles performed in patients with non-male factor infertility between April 2009 and March 2013 were included in this retrospective study. During the period, ICSI and conventional IVF were performed in 142 and 154 cycles, respectively. The usual indications for ICSI were in the cycles of patients with 1) known low fertilization rate, 2) repetitive implantation failure, 3) advanced maternal age, 4) presence of endometrioma, 5) low oocyte yield (number of oocytes ≤3), or 6) poor quality oocytes. The rate of TFF, normal fertilization, abnormal pronuclei (PN) formation, embryo quality, and pregnancy outcomes between the patients treated with ICSI and conventional IVF cycles were compared. Results The patients treated with ICSI (ICSI group, n = 142) presented fewer number of oocytes than patients treated with conventional IVF cycles (n = 154). The TFF rate was not different (4.2% vs. 0.6%, P = 0.059), but the ICSI group presented a significantly higher rate of normal fertilization (83.4% vs. 79.1%, P = 0.04) and lower rate of abnormal PN formation (3.9% vs. 13.3%, P < 0.01). The cleavage stage embryo quality was better in the ICSI group (grade A: 31.1% vs. 21.3%, P = 0.001; grade A + B: 65.1% vs. 47.6%, P < 0.001). Conclusion The result of this study does not support the use of ICSI to prevent TFF in patients with non-male factor infertility. However, ICSI improved the fertilization rate and the embryo quality.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014; 178. DOI:10.1016/j.ejogrb.2014.03.044 · 1.70 Impact Factor
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    • "The combination of three critical sperm parameters into a single indicator, which does not concern the more time consuming sperm morphology, turns it into a handy instrument in the practice of fertility treatments , available in the very same day of the procedure. After being established as a crucial parameter influencing the success of intrauterine insemination [1] [2], TMC was also tested as a predictor for fertilization failure and for pregnancy rates during in vitro fertilization treatment, yielding conflicting results [3] [4] [5]. Total motile sperm count was also described as a general predictor of sperm quality [6]. "
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    ABSTRACT: Total motile count (TMC) is a useful tool for sperm evaluation, comprising both quantitative and motility parameters. Although frequently used, TMC has not yet been evaluated as a contributory variable for intracytoplasmic sperm injection (ICSI) cycles. In this study we evaluate the possible role of TMC as a prognostic parameter in cycles designated for ICSI. We also test the existence of a possible TMC-threshold value that might be predictive for ICSI cycle outcome in the everyday practice. This is a retrospective cohort study in which the research question is addressed by a locally weighted regression (LOESS) analysis. Primary outcome measures are fertilization rate, good quality embryos rate and implantation rate. A total of 666 patients were included, contributing 1456 cycles. The effect of TMC over the fertilization rate was significant, depicting an inverted U-shaped curve: with up to approximately 10 million motile sperm, fertilization rates increased as TMC increased, but from this point on decreased. A slight increment in the rate of good embryo formation with increasing value of TMC was noted, but this did not reach a statistical significance. TMC values demonstrated no effect in the case of implantation rates. ICSI may offer an advantage related to fertilization rates for the sub-fertile male population, with a motile sperm count up to 10 million.
    International Journal of Molecular Epidemiology and Genetics 10/2012; 3(3):205-12. · 1.30 Impact Factor
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    • "Since its first introduction in 1992, intracytoplasmic sperm injection (ICSI) has been applied worldwide to treat severe male factor infertility and fertilization dysfunction. Recently, however ICSI has been increasingly used in cases where conventional in vitro fertilization (IVF) would not necessarily be inefficient (Oehninger and Gosden, 2002; van der Westerlaken et al., 2005; Kim et al., 2007). The advantage of ICSI with non-male factor infertility is still the subject of debate. "
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    ABSTRACT: Objective: To reevaluate whether relatively few oocytes obtained in one cycle are an indication for intracytoplasmic sperm injection (ICSI). Methods: A total of 406 cycles with three or fewer retrieved oocytes performed in 396 non-male infertile couples were retrospectively reviewed. Cycles were classified into three groups by different fertilization techniques: the in vitro fertilization (IVF) group, insemination with conventional IVF; the ICSI group, insemination with ICSI though semen parameters were normal; and the rescue ICSI group, re-insemination with ICSI after conventional IVF failure. Results: The ICSI group resulted in higher normal fertilization compared with the conventional IVF group. Correspondingly, the cycle cancellation rate was decreased in the ICSI group, though it was not statistically significant. The clinical pregnancy rate and implantation rate were lower in the ICSI group compared with the conventional IVF group. Rescue ICSI was a method to avert total fertilization failure in conventional IVF, increasing fertilization and ensuring embryo availability for transfer, but the normal fertilization was the lowest due to delayed insemination and the chance of pregnancy was very little. Conclusions: Obtaining only few oocytes in one cycle is not considered as an indication for ICSI when the sperm sample is apparently normal. Rescue ICSI is either not recommended if conventional insemination fails. Such patients should not be subjected to the unnecessary costs and potential risks of ICSI.
    Journal of Zhejiang University SCIENCE B 09/2012; 13(9):717-722. DOI:10.1631/jzus.B1100370 · 1.28 Impact Factor
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