Use and outcomes of intracytoplasmic sperm injection for non–male factor infertility

Objective

To determine whether intracytoplasmic sperm injection (ICSI) is associated with improved outcomes for non–male factor infertility.

Design

We examined the patient characteristics associated with treatment choice—ICSI and conventional in vitro fertilization (IVF)—among patients without a diagnosis of male factor infertility and compared outcomes between the two groups, adjusting for patient characteristics using multivariate regression models.

Setting

Academic fertility center.

Patient(s)

We evaluated 696 consecutive assisted reproductive technology (ART) cycles performed for couples with normal semen analysis at the Stanford Reproductive Endocrinology and Infertility Center between 2002 and 2003. We compared patient characteristics, cycle details, and outcomes for ICSI and IVF.

Main Outcome Measure(s)

Fertilization, pregnancy, and live birth rates.

Result(s)

Patient characteristics were similar between the two groups, except the proportion of patients with unexplained infertility (IVF 15.1% vs. ICSI 23.5%), previous fertility (IVF 62.6% vs. ICSI 45.5%), and previous ART cycle (IVF 41.2% vs. ICSI 67.7%). More oocytes were fertilized per cycle for the IVF group (6.6 oocytes versus 5.1 oocytes). Fertilization failure, pregnancy, and live birth rates did not differ between IVF and ICSI. Using logistic regressions, having had previous ART was found to be positively associated with ICSI. Treatment choice of ICSI was not associated with fertilization, pregnancy, or live birth rates.

Conclusion(s)

No clear evidence of improved outcomes with ICSI was demonstrated for non–male factor infertility.

Key Words: Intracytoplasmic sperm injection, assisted reproductive technology, infertility, outcomes, in vitro fertilization, female factor