A prospective randomized trial of conventional in vitro fertilization versus intracytoplasmic sperm injection in unexplained infertility

Foong, Shu; Fleetham, Judy; O’Keane, Joseph A.; Scott, S. G.; Tough, Suzanne; Greene, Calvin

doi:10.1007/s10815-005-9008-y

Cited by 64 publications

(55 citation statements)

References 16 publications

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“…We observed a lower rate of fertilization failure with conventional IVF than reported in split IVF-ICSI studies, which may also account for the finding that our fertilization rates were not different. Similar to other reports, we found no difference in the transfer rate or cryopreservation rate of embryos fertilized by ICSI or conventional IVF suggesting that insemination method does not alter embryo development (7, 10,23). Data regarding the effect of insemination method on implantation rate, clinical PR, or live birth rate are not reported in the literature given that studies of split IVF-ICSI have included mixed transfers of embryos fertilized by IVF or ICSI.…”

Section: Discussionsupporting

confidence: 90%

Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection

Vitek

Galárraga

Klatsky

et al. 2013

Fertility and Sterility

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Objective To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility. Design Adaptive decision model. Setting Academic infertility clinic. Patient(s) A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF. Intervention(s) Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes. Main Outcome Measure(s) Live birth rate, incremental cost-effectiveness ratio (ICER). Result(s) In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666. Conclusion(s) In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI.

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Section: Discussionsupporting

confidence: 90%

Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection

Vitek

Galárraga

Klatsky

et al. 2013

Fertility and Sterility

View full text Add to dashboard Cite

show abstract

“…Though it has been suggested that 6-10 oocytes is the ideal quantity to optimize the number of embryos ultimately transferred [21], retrospective analyses of poor response cycles and subsequent fertilization and pregnancy rates suggest that embryo transfer is still possible in this patient population and cycles should not be cancelled [19,22,23]. While there have been prospective trials to compare IVF outcomes in CI versus ICSI, women with poor ovarian response [24] or previous low responders [25] have had cycles cancelled or have been excluded. In couples without poor response to COH, ICSI has no proven benefit over CI and is a more invasive and expensive technique [24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

“…While there have been prospective trials to compare IVF outcomes in CI versus ICSI, women with poor ovarian response [24] or previous low responders [25] have had cycles cancelled or have been excluded. In couples without poor response to COH, ICSI has no proven benefit over CI and is a more invasive and expensive technique [24][25][26][27][28]. Prospective randomized trials studying low response to COH have not been performed.…”

Section: Discussionmentioning

confidence: 99%

Should ICSI be recommended routinely in patients with four or fewer oocytes retrieved?

Luna

Bigelow

Duke

et al. 2011

J Assist Reprod Genet

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Purpose To determine if patients with a low response to controlled ovarian hyperstimulation during IVF benefit from intracytoplasmic sperm injection (ICSI) Methods Retrospective analysis of 350 IVF cycles in which four or fewer oocytes were retrieved. Severe male factor cases were excluded from analysis. Conventional insemination (CI) and ICSI were compared, with primary outcome measures of fertilization rate, implantation rate, clinical pregnancy rate per embryo transfer, and pregnancy loss rate. Result(s) Fertilization rates per oocyte retrieved for CI and ICSI were comparable (51.5% vs. 51.8%). Parallel implantation rates (22% vs. 25%), clinical pregnancy rates (32.8% vs. 33.3%), and loss rates (26.7% vs. 39.5%) were also noted. No difference in cancelled cycles was reported. Conclusion(s) Our results demonstrate that in the presence of normal semen parameters, low egg number is not an indication to perform ICSI.

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“…While this approach has been tweaked and refined over the last 3-4 decades, the principles have remained. Contemporary human IVF/CI fertilization rates vary greatly, from 50 to 70% (Bhattacharya et al, 2001;Foong et al, 2006) and a 'true fertilization rate' following IVF/CI is unknown due to the presence of cumulus cells and inability to fully determine maturity of the oocyte within the cumulus mass. Since immature oocytes can be penetrated by sperm at the time of insemination, lack ability to form pronuclei or developmentally competent embryos, and yet still can progress to metaphase II (Van Blerkom et al, 1994), this interferes with a calculation of 'true fertilization'.…”

Section: Conventional Inseminationmentioning

confidence: 99%

Application of microfluidic technologies to human assisted reproduction

Smith

Takayama

2017

Mol. Hum. Reprod.

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Microfluidics can be considered both a science and a technology. It is defined as the study of fluid behavior at a sub-microliter level and the investigation into its application to cell biology, chemistry, genetics, molecular biology and medicine. There are at least two characteristics of microfluidics, mechanical and biochemical, which can be influential in the field of mammalian gamete and preimplantation embryo biology. These microfluidic characteristics can assist in basic biological studies on sperm, oocyte and preimplantation embryo structure, function and environment. The mechanical and biochemical characteristics of microfluidics may also have practical and/or technical application(s) to assisted reproductive technologies (ART) in rodents, domestic species, endangered species and humans. This review will consider data in mammals, and when available humans, addressing the potential application(s) of microfluidics to assisted reproduction. There are numerous sequential steps in the clinical assisted reproductive laboratory process that work, yet could be improved. Cause and effect relations of procedural inefficiencies can be difficult to identify and/or remedy. Data will be presented that consider microfluidic applications to sperm isolation, oocyte cumulus complex isolation, oocyte denuding, oocyte mechanical manipulation, conventional insemination, intracytoplasmic sperm injection, embryo culture, embryo analysis and oocyte and embryo cryopreservation. While these studies have progressed in animal models, data with human gametes and embryos are significantly lacking. These data from clinical trials are requisite for making future evidence-based decisions regarding the application of microfluidics in human ART.

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A prospective randomized trial of conventional in vitro fertilization versus intracytoplasmic sperm injection in unexplained infertility

Abstract: There were no differences in clinical outcomes associated with IVF versus ICSI in the treatment of unexplained infertility.

Cited by 64 publications

References 16 publications

Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection

Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection

Should ICSI be recommended routinely in patients with four or fewer oocytes retrieved?

Application of microfluidic technologies to human assisted reproduction

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