No abstract

No abstract

OBJECTIVE: To determine whether Intracytoplasmic Sperm Injection (ICSI) and standard controlled ovarian stimulation (COS) are the best initial approach for couples undergoing assisted reproduction (ART) with no indications for ICSI and with good ovarian reserve (good prognosis cases).DESIGN: Observational, retrospective and comparative study. MATERIALS AND METHODS: All patients undergoing ART between January 2008 and December 2015 were included. Inclusion criteria were patients % 35 years old, no severe male factor (sperm count % 5 mill/mL), good ovarian reserve (AFC >8 and AMH > 1ng/mL). Patients were divided in 3 groups per the doses of gonadotropins: group 1, mild stimulation (%150 UI per day); group 2, moderate (151-225 UI per day) and group 3, standard stimulation (R225 UI per day). In a secondary analysis, outcomes of conventional IVF and ICSI were compared according to the dose used.RESULTS: A total of 307 cycles were evaluated. There was no difference in demographics between groups (table 1) and similar number of mature oocytes were recovered. (p¼NS). Fertilization rate was higher in group 2 (81%) versus the other groups (59 and 62%, respectively) (p¼<0.001). Blastocyst yield was higher in group 1 (33%) (p¼0.002). Pregnancy rates were higher in groups 1 and 2 but the difference was not significant.In the secondary analysis, a total of 1529 oocytes were used, 65.3% for conventional IVF and 34.7% for ICSI. Fertilization rate (71% vs 59%) and blastocyst yield rate (27% vs 12%) were better in conventional IVF (p¼<0.001). Clinical pregnancy rates were higher in conventional IVF versus ICSI (48% vs 40%).CONCLUSIONS: Mild or moderate ovarian stimulation should be considered as the initial approach when no male factor or diminished ovarian reserve are the indications for IVF. The abuse of ICSI in absence of severe male factor and in good prognosis patients should be avoided as reproductive outcomes are better with conventional fertilization.