ICSI doesn't Improve live birth rate compared to IVF if male partners have normal sperm parameters: Lancet
Intracytoplasmic sperm injection (ICSI) does not improve the live birth rate than conventional IVF in couples with infertility in whom the male partner has a normal total sperm count and motility, finds a recent study.
The results of the study, published in the journal Lancet, challenge the value of routine use of ICSI in assisted reproduction techniques for this population given the additional cost and invasive nature of this technique.
In couples with non-male factor infertility, the use of intracytoplasmic sperm injection has increased worldwide substantially. However, there is a lack of data from randomized trials supporting this approach compared with conventional in-vitro fertilization (IVF). Vinh Q Dang, IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam, and colleagues aimed to investigate whether intracytoplasmic sperm injection would result in a higher livebirth rate compared with conventional IVF.
For this purpose, the researchers performed an open-label, multicentre, randomized trial at two IVF centres in Ho Chi Minh City, Vietnam. It included couples aged at least 18 years and the male partner's sperm count and motility (progressive motility) were normal based on WHO 2010 criteria. Couples had to have undergone two or fewer previous conventional IVF or intracytoplasmic sperm injection attempts, have used an antagonist protocol for ovarian stimulation, and agree to have two or fewer embryos transferred
1064 couples were randomly assigned in the ratio 1:1 to undergo either ICSI (n=532) or conventional IVF (n=532).
The primary outcome was livebirth after the first embryo transfer from the initiated cycle. Analyses were done on an intention-to-treat basis.
Key findings of the study include:
- Livebirth after the first embryo transfer from the initiated cycle occurred in 184 (35%) of 532 couples randomly assigned to intracytoplasmic sperm injection and in 166 (31%) of 532 couples randomly assigned to conventional IVF (absolute difference 3·4%; risk ratio [RR] 1·11).
- 29 (5%) couples in the intracytoplasmic sperm injection group and 34 (6%) couples in the conventional IVF group had fertilisation failure (absolute difference −0·9%, RR 0·85).
"In couples with infertility in whom the male partner has a normal total sperm count and motility, intracytoplasmic sperm injection did not improve the livebirth rate compared with conventional IVF," wrote the authors. "Our results challenge the value of the routine use of intracytoplasmic sperm injection in assisted reproduction techniques for this population."
Reference:
The study titled, "Intracytoplasmic sperm injection versus conventional in-vitro fertilisation in couples with infertility in whom the male partner has normal total sperm count and motility: an open-label, randomised controlled trial," is published in the journal Lancet.
DOI: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00535-3/fulltext
