ALWAYS ICSI? A SWOT analysis

Abstract

Purpose Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. Methods A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. Results The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. Conclusion Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.

Comparison of clinical and preimplantation genetic testing for aneuploidy outcomes between in vitro fertilization and intracytoplasmic sperm injection in sibling mature oocytes from high‐risk patients: A retrospective study

“…Furthermore, the clinical outcomes of this study showed that ICSI had slightly higher implantation and live birth or ongoing pregnancy rates and lower miscarriage rates than IVF. However, no significant difference was observed between the groups, similar to the findings of a previous study, in which a comparison of the efficacy of IVF and ICSI showed a slight but nonsignificant difference based on patient characteristics and factors 34 . Therefore, these findings support the notion that IVF, along with ICSI, is an equally useful method of inseminitation, not only in general patients but also particularly high‐risk patients.…”

ICSI Does Not Improve Live Birth Rates but Yields Higher Cancellation Rates Than Conventional IVF in Unexplained Infertility

“…However, whether ICSI should be preferred to in vitro fertilization (IVF) for patients with unexplained infertility remains an open question. Oocyte damage is one of the potential problems with this invasive technique, which is unpredictable and unsystematic in nature ( 6 – 8 ). Thus, several clear end points need to be assessed if advocating the routine use of ICSI in unexplained infertility: normal fertilization rates, embryo quality, implantation rates, and live birth rates.…”

Comparing the prognosis of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer between unexplained primary infertility patients with repeated artificial insemination with homologous semen failure and tubal infertility patients

“…This technique is more invasive and expensive than conventional IVF‐ET. However, there is an increasing trend of using ICSI‐ET for couples with UI 17 . Moreover, evidence demonstrating the effectiveness of IVF/ICSI‐ET in UAIHF patients is still limited.…”

“…However, there is an increasing trend of using ICSI-ET for couples with UI. 17 Moreover, evidence demonstrating the effectiveness of IVF/ICSI-ET in UAIHF patients is still limited. In general, TI patients tend to experience a low risk of fertilization failures, as they have had one or more natural conceptions, and UAIHF patients are more likely to suffer fertilization failures due to unknown etiologies.…”