Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Boulet, Sheree L.; Mehta, Akanksha; Kissin, Dmitry M.; Warner, Lee; Kawwass, Jennifer F.; Jamieson, Denise J.
• Is Part Of: Obstetrical & gynecological survey. Volume 70:Issue 5(2015)
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; Generative organs, Female -- Surgery -- Periodicals; 618
• DOI: 10.1097/OGX.0000000000000198
• Languages: English
• ISSNs: 0029-7828

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>ABSTRACT</title> <p>Since its introduction in 1992, intracytoplasmic sperm injection (ICSI) has been increasingly used in patients without severe male factor infertility despite the lack of clear evidence of a benefit over conventional in vitro fertilization (IVF). Compared with pregnancies resulting from conventional IVF, pregnancies resulting from the use of ICSI are associated with 1.5 to 4 times increased risk of chromosomal abnormalities, birth defects, intellectual disabilities, imprinting disorders, and autism. Intracytoplasmic sperm injection is considerably more expensive than conventional IVF.</p> <p>The aim of this retrospective observational study was to assess national trends and reproductive outcomes of fresh IVF cycles associated with the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use. Although only fresh embryos were transferred, it is unlikely that outcomes for frozen-thawed embryos would differ. Data were obtained from the US National Assisted Reproductive Technology Surveillance System for all fresh and ICSI cycles performed during 1996 to 2012.</p> <p>The primary study outcomes were (1) trends in use of ICSI during 1996 to 2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield (<5 oocytes retrieved), and 2 or more prior assisted reproductive technology cycles and no prior live birth, and (2) reproductive outcomes during 2008 to 2012 for conventional IVF and ICSI cycles, stratified by the presence or absence of male factor infertility.</p> <p>A total of 1, 395, 634 fresh IVF cycles were identified between1996 and 2012; 908, 767 (65.1%) used ICSI, and 486, 867 cycles (34.9%) used conventional IVF. Male factor infertility was identified in 499, 135 (35.8%) of fresh cycles. During 2006 to 2012, ICSI use among cycles with male factor infertility increased from 76.3% (10, 876/14, 259) to 93.3% (32, 191/34, 506) (<italic>P</italic> < 0.001), whereas its use for those without male factor infertility increased from 15.4% (4, 197/27, 191) to 66.9% (42, 321/63, 250) (<italic>P</italic> < 0.001). During 2008 to 2012, 494, 907 fresh IVF cycles were identified, 74.6% of which used ICSI. Male factor infertility was reported in 35.7% (176, 911/494, 907) of fresh cycles. The risk for multiple births among these cycles was significantly lower in those undergoing ICSI compared with conventional IVF (30.9% vs 34.2%); the adjusted relative risk (RR) was 0.87, with a 95% confidence interval (CI) of 0.83 to 0.91.</p> <p>Compared with conventional IVF, ICSI use among cycles without male factor infertility (n = 317, 996) 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 births (30.1% vs 31.0%; adjusted RR, 0.93; 95% CI, 0.91–0.95).</p> <p>These findings show that ICSI use among fresh IVF cycles in the United States increased from 36.4% to 76.2% between 1996 and 2012. The largest relative increase occurred in cycles without male factor infertility. The data show no improvement in postfertilization reproductive outcomes with use of ICSI over conventional IVF in the absence of male factor infertility, irrespective of male factor infertility diagnosis.</p> </sec> </abstract>