Purpose: To compare the clinical outcomes of extremely poor responders with one or two oocytes who receive in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Methods: A retrospective study was carried out in 2572 patients with one or two oocytes retrieved from 2013 to 2022, of which 2159 patients were scheduled to receive IVF treatment and 413 patients were scheduled to receive ICSI treatment. The laboratory parameters and clinical outcomes were compared with adjusted multivariate regression and propensity score (PS) matching.
Results: In both matched and non-matched cohorts, the total fertilization failure (TFF) rate of the ICSI group was significantly higher than that of the IVF group (P < 0.05), but the multiple fertilization rate of the IVF group was significantly higher than the ICSI group (P < 0.05). After matching, the cumulative pregnancy rate per initiated cycle in the IVF group was significantly higher than in the ICSI group (28.7% vs 21.7, P=0.028). However, the difference in cumulative live births did not reach significant (21.2 % vs 17.2 %, P =0.179). The adjusted odds ratios for TFF, cumulative pregnancy, and cumulative live birth comparing ICSI versus IVF in multivariate models were 1.65(95%CI: 1.12, 2.43), 0.65(95%CI: 0.46, 0.91), and 0.76(95%CI:0.55, 1.04) respectively.
Conclusion: In poor responders with one or two oocytes retrieved, ICSI insemination cannot avoid TFF, and it may hamper the cumulative pregnancy rate.