Abstract
Purpose: Intracytoplasmic sperm injection (ICSI) guarantees high fertilization rates and could theoretically lead to higher implantation rates as well. Furthermore injection into oocyte creates a hole in the zona pellucida similar to the procedure of assisted hatching. We were therefore interested to assess such a potential benefit for infertile IVF patients without male factor.
Materials and Methods: Open randomized prospective study according to the rules “Good Clinical Practice” with informed consent of the patients and institutional review board approval. Ninety-one consecutively seen patients with tubal infertility or hostile cervical mucus were randomized to undergo either ICSI (44 patients) or IVF (45 patients). In two patients fertilization of oocytes failed and so a repeated ICSI had to be performed. All these patients were stimulated with the same protocol, using the gonadotropin releasing hormone-agonist (GnRH-a) buserelin acetate in an ultrashort flair-up protocol together with pure follicle stimulating hormone (rFSH). The two study groups did not differ in terms of age, BMI, and all baseline hormone levels.
Results: The total pregnancy rate was 42% in the normal IVF group with 33% ongoing pregnancies. The ICSI group had a total pregnancy rate of 39% with 23% ongoing pregnancies. The implantation rate per transferred embryo was higher for normal IVF but not significant (18% versus 11%). The variables, fertilization rate, age, body mass index, baseline hormone levels, endometrial thickness, embryo score, and the highest grade embryo per transfer were very similar in both groups.
Conclusion: ICSI should be applied only when conventional IVF fails, that is, for male factor patients and for patients with unexplained infertility.
Similar content being viewed by others
REFERENCES
Palermo G, Joris H, Devroey P, Van Steirteghem AC: Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992;340:17,18
Van Steirteghem AC, Nagy Z, Joris H, Liu J, Steassen C, Smitz J: High fertilization and implantation rates after intracytoplasmic sperm injection. Hum Reprod 1993;8:1061-1066
Payne D, Flaherty SP, Jeffrey R, Warnes GM, Matthews CD: Successful treatment of severe male factor infertility in 100 consecutive cycles using intracytoplasmic sperm injection. Hum Reprod 1994;9:2051-2057
Mansour RT, Abloulghar MA, Serour GI, Amin YM, Ramzi AM: The effect of sperm parameters on the outcome of intracytoplasmic sperm injection. Fertil Steril 1995;64:982-986
Cohen J, Elsner C, Kort H, Malter H, Massey J, Mayer MP: Impairment of the hatching process following IVF in the human improvement of implantation of assisting hatching using micromanipulation. Hum Reprod 1990;5:7-13
Tsirigotis M, Yang D, Redgment CJ, Nicholson N, Pelekanos M, Craft IC: Assisted fertilization with intracytoplasmic sperm injection. Fertil Steril 1994;62:781-785
World Health Organization. Laboratory Manual for the Examination of Human Semen and Semen-Cervical Mucus Interaction, 3rd edn. New York, Cambridge University Press, 1993, pp 3-27
Aboulghar MA, Mansour RT, Serour GI, Sattar MA, Amin YM: Intracytoplasmic sperm injection and conventional in vitro fertilization for sibling oocytes in cases of unexplained infertility and borderline semen. J Assist Reprod Genet 1996;13:38-42
Steer CV, Mills CL, Tan SL: The cumulative embryo score. A predictive embryo scoring technique to select the optimal number of embryos to transfer in an in-vitro fertilization and embryo transfer program. Hum Reprod 1992;117-119
Miller KF, Goldberg JM: In vitro development and implantation rates of fresh and cryopreserved sibling zygotes. Obstet Gynecol 1995;85:999-1002
Abloulghar MA, Mansour RT, Serour GI, Amin YM: The prognostic value of successful in-vitro fertilization in subsequent trails. Hum Reprod 1994;9:1932-1934
Hamberger L, Sjogren A, Lundin K, Soderlund B, Nilsson L, Bergh C: Microfertilization techniqhes-the Swedish experience. Reprod Fertil Dev 1995;7:263-268
Aboulghar MA, Mansour RT, Serour GI, Amin YM, Kamal A: Prospective controlled randomized study of in vitro fertilization versus intracytoplasmic sperm injection in the treatment of tubal factor infertility with normal semen parameter. Fertil Steril 1996;66:753-756
Bukulmez O, Yarali H, Yucel A, Sari T, Gurgan T: Intracytoplasmic sperm injection versus in vitro fertilization for patients with a tubal factor as their sole cause of infertility: A prospective, randomized trial. Fertil Steril 2000;73:38-42
Molly O, Martin M, Speirs A, Lopata A, Clark G, MaBain J: Performance of patients with a “frozen pelvis” in an in vitro fertilization program. Fertil Steril 1987;47:450-455
Miller KF, Falcone T, Goldberg JM, Attaran M: Previous fertilization failure with conventional in vitro fertilization is associated with poor outcome of intracytoplasmic sperm injection. Fertil Steril 1998;69:242-245
Yang D, Shahata MA, Al-Bader M, Al-Natsha S, Al-Flamerzia M, Al-Shawaf T: Intracytoplasmic sperm injection improving Embryo quality: Comparison of sibling oocytes of non-malefactor couples. J Assist Reprod Genet 1996;13:351-355
Navot D, Muasher SJ, Oehninger S, Liu HC, Veeck LL, Kreiner D: The value of in vitro fertilization for the treatment of unexplained infertility. Fertil Steril 1988;49:854-857
Ruiz A, Remohi J, Minguez Y, Guanes PP, Simon C, Pellicer A: The role of in vitro fertilization and intracytoplasmic sperm injection in couples with unexplained infertility after failed intrauterine insemination. Fertil Steril 1997;68:171-173
Oehninger S, Veeck L, Lanzendorf S, Maloney M, Toner J, Muasher S: Intracytoplasmic sperm injection: Achievement of high pregnancy rates in couples with severe male factor infertility is dependent primarily upon female and not male factors. Fertil Steril 1995;64:977-981
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Poehl, M., Holagschwandtner, M., Bichler, K. et al. CLINICAL ASSISTED REPRODUCTION: IVF-Patients With Nonmale Factor “To ICSI” or “Not to ICSI” That is the Question?. J Assist Reprod Genet 18, 207–210 (2001). https://doi.org/10.1023/A:1009403928600
Issue Date:
DOI: https://doi.org/10.1023/A:1009403928600