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Intracytoplasmic Sperm Injection versus Conventional In Vitro Fertilization in Unexplained Infertility
Journal article   Open access   Peer reviewed

Intracytoplasmic Sperm Injection versus Conventional In Vitro Fertilization in Unexplained Infertility

Aya Iwamoto, Karen M. Summers, Amy Sparks and Abigail C. Mancuso
F&S Reports (Online), Vol.5(3), pp.263-271
06/2024
DOI: 10.1016/j.xfre.2024.06.003
PMCID: PMC11456666
PMID: 39381653
url
https://doi.org/10.1016/j.xfre.2024.06.003View
Published (Version of record) Open Access

Abstract

To compare cumulative live birth rate (CLBR) and cost-effectiveness of intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilization (cIVF) Retrospective cohort study of cycles reported to Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Patients with unexplained infertility who underwent first autologous retrieval cycles between January 2017 and December 2019 with linked fresh and frozen embryo transfers through December 2021. ICSI versus cIVF Primary outcome was CLBR, defined as up to one live birth from a retrieval cycle and all linked embryo transfers. Secondary outcomes included 2 pronuclear (2PN) per oocyte retrieved, miscarriage rate, and total number of transferred or frozen embryos per 2PN. Subsamples with and without preimplantation genetic testing for aneuploidy (PGT-A) were analyzed. Outcomes were adjusted for age, body mass index, number of oocytes retrieved, length of follow up, and clinic ICSI use rate. A total of 18,805 patients with unexplained infertility were included. No difference in CLBR was found among cycles without genetic testing (54.4% ICSI vs. 57.5% cIVF) and with PGT-A (47.6% ICSI vs. 51.8% cIVF). ICSI cycles without genetic testing had a higher miscarriage rate (16.4% vs. 14.4%) but no difference was seen in cycles with PGT-A (13.9% ICSI vs. 13.2% cIVF). ICSI cycles had a significantly lower ratio of 2PN per oocyte retrieved without genetic testing (59.7% vs. 60.9%) and with PGT-A (63.3% vs. 65.8%). Ratio of embryos transferred or frozen per 2PN were not significantly different in cycles without genetic testing (49.4% vs. 49.6%) or with PGT-A (54.2% vs. 55.2%). Total fertilization failure occurred in 216 patients (4%) who underwent cIVF and in 153 patients (1.1%) who utilized ICSI. Compared to cIVF alone, an estimated additional $11,011,500 was charged to patients for ICSI without genetic testing and $9,010,500 was charged to patients for ICSI with PGT-A over 2 years by SART clinics. Based on total fertilization failure rates, 35 patients would require treatment with routine ICSI to avoid a single cycle of total fertilization failure with cIVF. Routine use of ICSI in unexplained infertility is not warranted due to the additional cost and lack of CLBR benefit.
 conventional IVF cumulative live birth rate ICSI unexplained infertility

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