Is there a reason to perform ICSI in the absence of male factor? Lessons from the Latin American Registry of ART

Abstract

Study question Does the use of ICSI offer any outcome advantage over IVF in patients with non-male factor infertility? Summary answer We did not find any outcome improvement that justifies the routine use of ICSI over IVF in non-male factor ART cycles. What is already known Since its introduction in Latin America, the use of ICSI has increased substantially, even among patients without male factor infertility. However, it is not clear whether ICSI provides an advantage over IVF in non-male factor infertility. Study design size, duration A retrospective cohort study of fresh cycles performed in 155 ART clinics located in 15 Latin American countries between 2012 and 2014. Records were assessed for 49,813 ART cycles (39,564 ICSI and 10,249 IVF) performed in infertile couples who did not have male factor infertility. Student’s t -test was used to analyze normally distributed data, Wilcoxon test to analyze non-normally distributed data, and Fisher’s exact test for categorical data. Logistic regression was used to quantify the effect of ICSI on delivery rate, adjusting for age of female partner, number of oocytes inseminated, number of embryos transferred, and transfer at blastocyst stage as possible confounding factors. Poisson regression analysis was used to quantify the effect of ICSI on fertilization rate, adjusting for age of female partner. Participants/materials, setting, method Cycles with the diagnosis of male factor and use of cryopreserved semen and with a freeze-all strategy were excluded. Main results and the role of chance After correcting for age of female partner, number of oocytes inseminated, number of embryos transferred and transfer at blastocyst stage, we found that the use of ICSI was associated with a significant decrease in the odds of delivery compared to IVF (odds ratio 0.88, 95% CI 0.84 to 0.93; P < 0.0001). Limitations reasons for caution An important limitation of this study is the lack of randomization owing to its retrospective nature. This could result in selection bias, i.e. couples with the worst prognosis undergoing ICSI, or patients with a history of fertilization failure in IVF cycles undergoing ICSI. More than one cycle from the same couple may be included in the study. Wider implications of the findings The lack of an outcome benefit—and, indeed, a reduced likelihood of delivery—following ICSI in non-male factor infertile couples suggests that ICSI may not be the most appropriate clinical approach in these patients. Study funding/competing interest(s) None.

The Impact of Intracytoplasmic Sperm Injection in Non-Male Factor Infertility—A Critical Review

“…Two retrospective reviews showed slightly differing results from each other. One was an analysis of the Latin America Registry of Assisted Reproductive Technology (ART) of nearly 50,000 ART cycles from 2012 to 2014 and determined that although FR did not differ between the two groups, LBR was higher (22.99% vs. 28.76%, p < 0.001) and TFF was actually lower (4.49% vs. 3.37%, p < 0.001) in the IVF group [10]. The other retrospective analysis from 2009-2015 with over 3000 patients found that FR and LBR per cycle were higher in IVF than ICSI (67.1% vs. 62.3% p < 0.0001, 17.22% vs. 13.2% p < 0.001, respectively).…”

Novel Techniques of Sperm Selection for Improving IVF and ICSI Outcomes

“…Therefore, the recommendation is to use always IVF as first choice and ICSI only in the following cases: testicular and epididymal spermatozoa, immotile but viable spermatozoa, asthenozoospermia, globozoospermia, teratozoospermia, and with frozen spermatozoa (Tournaye, 2012). However, because ICSI has been proven to report the same efficiencies as IVF (Schwarze et al, 2017), nowadays this is the most used technique in fertility treatments in developed countries, replacing IVF as the first choice (71.3 and 72% of total cycles were performed by ICSI in Europe in 2014 and in United States in 2016, respectively) (CDC, 2018; De Geyter et al, 2018). This goes against the effectiveness of the last spermatozoa selection barriers imposed by the oocyte during IVF.…”

Irreversible electroporation ablation of end‑stage metastatic retroperitoneal lesions: Report on three cases and literature review

“…Furthermore, in the present study, confounding factors should be considered, and individual heterogeneous factors, including individual histories of therapeutic treatments and lifestyle changes, may have exaggerated the palliative treatment effects determined. Furthermore, long-term adjuvant effects may lead to selection bias (27)(28)(29). However, taking all of these limita- (27)(28)(29).…”

“…Furthermore, long-term adjuvant effects may lead to selection bias (27)(28)(29). However, taking all of these limita- (27)(28)(29). However, taking all of these limita-.…”