Comparison of ICSI and conventional IVF in non-male factor patients with less than four oocytes

Abstract

Background: We aimed to analyse our clinical results for a particular subgroup of patients with poor ovarian response (POR) in order to clarify if lower number of oocytes is a drawback for proceeding to C-IVF Materials and methods: In this retrospective study, patient les of all couples (#1733) who underwent oocyte retrieval between January 2017 and December 2019 were reviewed and 191 cases diagnosed with non-male factor infertility in which ≤3 cumulus-oocyte-complexes available for fertilisation were analysed. Exclusion criteria were: woman age>42, patients with a history of previous ART trial, prenatal genetic testing cycles and couples undergoing total cryopreservation for any indication. Three groups were constructed depending on the method of fertilisation and on semen quality as follows: IVF non-male factor (Group 1,n=77); ICSI non-male factor (Group 2, n=65); ICSI male factor-ICSI/MF n=49 according to WHO reference values. Main outcome parameters were: fertilisation rate, implantation rate and live birth rate.Results: Fertilisation rate per collected COC was signi cantly higher in group 1 compared to the other two groups (85,68%, 72,58%, 73,33% respectively, p=0,004). FR per inseminated oocyte also tended to be higher in group 1 but not reaching a statistically signi cant level. Both techniques yielded similar implantation rates (20,42%, 28,49%, 23,33% respectively, p=0,407) and live birth rates (26,8%, 30,6%, 31,1% respectively, p=0.643).Conclusions: In the presence of normal semen parameters, low egg number is not an indication to perform ICSI. The choice of fertilisation method should be based primarily on semen quality, in combination with the patient's previous history regardless of the ovarian reserve.

Reproductive outcomes of conventional in vitro fertilization and intracytoplasmic sperm injection in patients with non-severe male infertility across poor and different sub-optimal ovarian response categories: a cohort study based on 30352 fresh cycles from 2009-2019

“…A retrospective study based on 62,641 stimulated fresh cycles of the POR cohort suggested that the fertilization rate was lower in conventional IVF cycles (16). However, another retrospective study revealed that in patients with ≤ 4 oocytes retrieved, the fertilization rate was better via conventional IVF, whereas implantation rates, live birth rates, and miscarriage rates were similar (15). Despite its debatable e cacy and safety, ICSI has become the most commonly used ART technique worldwide, with broadened indications including low oocyte yield, prior fertilization failure with conventional IVF, and advanced maternal age (19).…”

“…Unpredictable oocyte damage may be caused by ICSI invasiveness, which has always been a critical point, including damage to the cytoplasm of oocytes caused by the injection needle (26, 27), damage to the metaphase II (MII) spindle caused by inaccurate positioning of the injection needle (28) or DNA damage and chromosomal aberrations caused by inappropriate sperm pretreatment (29,30). A retrospective analysis demonstrated that CPR and LBR with ICSI were signi cantly lower than those with conventional IVF in normozoospermic men (31), whereas some studies found no differences in CPR and LBR for either method of fertilization (15,16). Our results were in line with most previous studies, that is, IR, CPR, and LBR were higher in conventional IVF cycles, independent of the number of oocytes retrieved.…”

“…However, to the best of the authors' knowledge, there is a paucity of comparisons of the clinical effects of conventional IVF and ICSI across poor (1-3 oocytes retrieved) and suboptimal (4-9 oocytes retrieved) ovarian response categories (13,14). There were some limitations in the previous studies, such as limited sample size (15), less detailed study outcomes (16), and failure to conform to standards (17).…”

Opportunities and Limits of Conventional IVF versus ICSI: It Is Time to Come off the Fence

“…Nonetheless, the authors argued that this result should be interpreted as showing no evident benefit of ICSI over c-IVF in the presence of normal sperm parameters. The most recent retrospective analysis of women with ≤3 oocytes available also concluded that low oocyte number is not an indication to perform ICSI when the sperm parameters are within normal WHO ranges and the decision of the insemination method should be solely based on semen quality [ 62 ]. Indeed, implantation rate, live birth rate and fertilization failure rate were similar when the cycles of n = 77 c-IVF and n = 65 ICSI patients were compared.…”