Is Intracytoplasmic Sperm Injection the Solution for all in Unexplained Infertility?

Abstract

Intracytoplasmic sperm injection (ICSI) was first introduced as a supplemental method to conventional in vitro fertilization (c-IVF) for couples with severe male factor infertility to overcome the poor fertilization rate, while its indications expanded in current clinical practice and gained worldwide popularity. However, ICSI is invasive and crosses all natural barriers, raising several unresolved concerns regarding procedure-dependent and procedure-independent risks, as well as the characteristic of being labor-intensive and more expensive than c-IVF. This review is aimed to draw readers' attention, to the widespread use of ICSI worldwide, with its effectiveness in different indications of infertility, especially in those with unexplained infertility, as well as the cost-effectiveness of the ICSI-for-all strategy. Also, we covered current evidence on the short- and long-term safety of children born thanks to ICSI-aided conception. Further well-designed, adequately powered, and randomized controlled clinical trials are absolutely needed to arrive at a consensus on the use of ICSI over c-IVF in different populations.

Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles

“…It should be remembered that some of these conditions seem to be paternal age‐related, such as schizophrenia, 52 Down, 53,54 and Apert 53 syndromes. Moreover, ICSI is more time‐ and resource‐consuming compared to IVF 55 . As a confirmation, the ICSI cost‐effectiveness was evaluated by some authors showing that a 3.3% increase in live birth rate could be achieved with an incremental cost of $29,666 compared to IVF 56 .…”

“…Moreover, ICSI is more time‐ and resource‐consuming compared to IVF. 55 As a confirmation, the ICSI cost‐effectiveness was evaluated by some authors showing that a 3.3% increase in live birth rate could be achieved with an incremental cost of $29,666 compared to IVF. 56 Here, we confirm a greater ICSI application compared to IVF in a large series of over 20,000 fresh cycles.…”

Modeling the diagnosis and control infertility couples with different factors

“…Intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) are different in the method of egg fertilization. In IVF, an egg is placed in a Petri dish while surrounded by sperm; however, in ICSI, a single sperm is injected into an egg [42]. ICSI is one of the most noticeable breakthroughs in ART and has overcome the low rates of conventional in vitro fertilization (c-IVF) fertilization when the sperm parameters are poor [30].…”

Opportunities and Limits of Conventional IVF versus ICSI: It Is Time to Come off the Fence

“…Conventional IVF and ICSI differ for the way eggs are fertilized: in the former, a woman’s eggs are surrounded by sperm in a Petri dish and ultimately one sperm fertilizes the egg, while in the latter, an embryologist selects a single sperm from a semen sample and injects it directly into the egg. Notably, the broadening of initial indications for ICSI over the years has not been substantiated by the improvement of ART outcomes [ 6 ]. In line, the National Institute for Health & Care Excellence (NICE) guidelines recommend the use of ICSI only for severe deficits of the sperm quality or for couples in whom a previous IVF treatment cycle has resulted in failed or very poor fertilization [ 7 ].…”