Journal article
Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection
JAMA : the journal of the American Medical Association, Vol.313(3), pp.255-263
01/20/2015
DOI: 10.1001/jama.2014.17985
PMCID: PMC4343214
PMID: 25602996
Abstract
IMPORTANCE Intracytoplasmic sperm injection (ICSI) is increasingly used in patients without severe male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF).
OBJECTIVE To assess national trends and reproductive outcomes for fresh IVF cycles (embryos transferred without being frozen) following the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use.
DESIGN, SETTING, AND POPULATION Retrospective cohort study using data on fresh IVF and ICSI cycles reported to the US National Assisted Reproductive Technology Surveillance System during 1996-2012.
MAIN OUTCOMES AND MEASURES Trends in ICSI use during 1996-2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield, and 2 or more prior assisted reproductive technology cycles; reproductive outcomes for conventional IVF and ICSI cycles during 2008-2012, stratified by the presence or absence of male factor infertility.
RESULTS Of the 1 395 634 fresh IVF cycles from 1996 through 2012, 908 767 (65.1%) used ICSI and 499 135 (35.8%) reported male factor infertility. Among cycles with male factor infertility, ICSI use increased from 76.3%(10 876/14 259) to 93.3%(32 191/34 506) (P < .001) during 1996-2012; for those without male factor infertility, ICSI use increased from 15.4%(4197/27 191) to 66.9%(42 321/63 250) (P < .001). During 2008-2012, male factor infertility was reported for 35.7%(176 911/494 907) of fresh cycles. Among those cycles, ICSI use was associated with a lower multiple birth rate compared with conventional IVF (30.9% vs 34.2%; adjusted relative risk [RR], 0.87; 95% CI, 0.83-0.91). Among cycles without male factor infertility (n = 317 996), ICSI use was associated with lower rates of implantation (23.0% vs 25.2%; adjusted RR, 0.93; 95% CI, 0.91-0.95), live birth (36.5% vs 39.2%; adjusted RR, 0.95; 95% CI, 0.93-0.97), and multiple live birth (30.1% vs 31.0%; adjusted RR, 0.93; 95% CI, 0.91-0.95) vs conventional IVF.
CONCLUSIONS AND RELEVANCE Among fresh IVF cycles in the United States, ICSI use increased from 36.4% in 1996 to 76.2% in 2012, with the largest relative increase among cycles without male factor infertility. Compared with conventional IVF, ICSI use was not associated with improved postfertilization reproductive outcomes, irrespective of male factor infertility diagnosis.
Details
- Title: Subtitle
- Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection
- Creators
- Sheree L. Boulet - Centers for Disease Control and PreventionAkanksha Mehta - Emory UniversityDmitry M. Kissin - Centers for Disease Control and PreventionLee Warner - Centers for Disease Control and PreventionJennifer F. Kawwass - Emory UniversityDenise J. Jamieson - Emory University
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.313(3), pp.255-263
- Publisher
- Amer Medical Assoc
- DOI
- 10.1001/jama.2014.17985
- PMID
- 25602996
- PMCID
- PMC4343214
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Number of pages
- 9
- Grant note
- UL1TR000454 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) UL1TR000454 / National Center for Advancing Translational Sciences of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
- Language
- English
- Date published
- 01/20/2015
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446410202771
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