To determine if the use of ICSI in women of advanced maternal age with non-male factor infertility increases chances of live birth.
Retrospective data analysis of 10 years of cycle data from a single Australian IVF clinic (Repromed). First cycle patients only of an advanced maternal age (≥ 35 years) with non-male factor infertility utilising standard IVF or ICSI insemination and having at least three oocytes collected at egg pick up were assessed for live birth following transfer of single genetically unscreened blastocyst (N = 577). Subanalysis of clinical pregnancy, miscarriage, fertilisation, embryo utilisation rate and having a blastocyst for transfer were considered. Unadjusted, covariate adjusted and propensity score weighted analysis were performed.
The use of standard IVF insemination in women ≥ 35 years with non-male factor infertility increased the chance of a live birth compared with ICSI insemination (unadjusted OR = 2.72, 95% CI [1.78, 4.17]; adjusted OR = 2.64, 95% CI [1.64, 4.27] and weighted OR = 2.26, 95% CI [1.72, 2.98] 31% vs 14%). All other outcomes (fertilisation rate, embryo utilisation, blastocyst for embryo transfer and miscarriage rate) were unaffected.
In couples with advanced maternal age and non-male factor infertility, standard IVF insemination appears to increase the chance of a live birth compared with ICSI. As such, the results of this study support the use of routine IVF as the preferred insemination technique for older women in non-male factor infertility. However, future randomised controlled trials are still required to assess this policy.
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NOM is the recipient of the NHMRC Peter Doherty Early Career Fellowship.
Conflict of interest
NOM, LPI and KT declare that they are paid employees of Monash IVF Group Lmt.
Institutional Scientific Advisory Board (SAC) (Project number 1M2020) approved this retrospective study. Patients had previously given written consent to allow their records to be accessed for these types of low-risk retrospective audit type studies.
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McPherson, N.O., Vincent, A.D., Pacella-Ince, L. et al. Comparison of in vitro fertilisation/intracytoplasmic sperm injection on live birth rates in couples with non-male factor infertility and advanced maternal age. J Assist Reprod Genet 38, 669–678 (2021). https://doi.org/10.1007/s10815-020-02026-8