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24B - ICSI Should Be Used for All IVF Cycles

Against

from Section IV - Embryology

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

The idea that ICSI should be used for all IVF cycles is held by some of my colleagues. The article will debunk the reasoning behind this, by providing rational arguments for the preferential use of conventional IVF (cIVF). Some of the risks associated with ICSI will be highlighted, all of which are eliminated by the use of cIVF. A simple mathematical model will be provided that shows, via use of benchmark KPIs, how more fertilised oocytes can result from cIVF compared to ICSI. This will then be backed up with evidence from studies showing that there is still no data to support the routine use of ICSI for non-male factor infertility. More worryingly, there is now data to show that ICSI actually decreases the chance of success compared to cIVF. Finally, the additional costs associated with providing ICSI will be revealed, showing the vast amount of money that is paid to clinics for patients to access ICSI treatment, when cIVF would have offered them a better chance of conception.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2021

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References

ESHRE Special Interest Group of Embryology, ALPHA. The Vienna consensus: report of an expert meeting on the development of art laboratory performance indicators. Hum Reprod Open. 2017;2.Google Scholar
Ding, D, Wang, Q, Li, X, et al. Effects of different polyvinylpyrrolidone concentrations on intracytoplasmic sperm injection. Zygote. 2020;14:16.Google Scholar
Practice Committees of the American Society for Reproductive Medicine and Society for Assisted Reproductive Technology. Intracytoplasmic sperm injection (ICSI) for non-male factor infertility: a committee opinion. Fertil Steril. 2012;98(6):1395–9.Google Scholar
Sustar, K, Rozen, G, Agresta, F, et al. Use of intracytoplasmic sperm injection (ICSI) in normospermic men may result in lower clinical pregnancy and live birth rates. Aust NZ J Obstet Gynaecol. 2019;59:706–11.CrossRefGoogle ScholarPubMed
Focus on Reproduction. Best of ESHRE & ASRM. ICSI: Fertilisation for all or only for male factor indications? Published April 8, 2019. www.focusonreproduction.eu/article/ESHRE-Meetings-BOEA-2019-ICSI.Google Scholar

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