IVF or ICSI: which is better in women with endometriosis associated infertility?

Abstract

subjects who did not have a semen analysis and had microdroplet fertilization due to a normal HEPT. There was no difference in mean fertilization rates between these groups (92.71, 88.42-97.01) vs. (92.47, 89.74-95.20) (p ¼ 0.9252). CONCLUSIONS: The HEPT is similar to WHO-V morphology in predicting successful microdroplet fertilization, while allowing decreased utilization of ICSI. In addition, it appears to be a reasonable additional test to determine which couples with an abnormal morphology might have a successful microdroplet fertilization. References: 1. Practice Committees of the American Society for Reproductive, M. and T. Society for Assisted Reproductive, Intracytoplasmic sperm injection (ICSI) for non-male factor infertility: a committee opinion.

Does Ovarian Endometriosis Increase Oocyte Sensitivity to ICSI-Induced Mechanical Damage?

“…Our findings are different from those of previously published studies [8][9][10][11][12], despite the fact that they were performed on patient populations with clinical characteristics comparable to those observed in our population. The inclusion of a higher rate of women with more severe forms of endometriosis (higher endometriosis score) in the previously studied cohorts cannot be excluded, and could potentially explain the discrepancy in the observed results.…”

“…A study in which sibling oocytes of women with endometriosis aged 25-40 were inseminated by either cIVF or ICSI using normal semen showed a higher fertilization rate by ICSI, but a surprisingly low ongoing pregnancy rate (15.6%), raising the suspect of an ICSI-induced mechanical damage on oocytes [11]. Another recent retrospective article reported that patients with advanced endometriosis (including those with endometrioma) undergoing ICSI with normal semen had a significantly lower pregnancy and live birth rate than those undergoing cIVF [12]. As it is quite well established that semen quality affects ICSI results [13], taken together these results obtained performing ICSI with normal semen suggest that patients with an endometrioma could have a peculiar oocyte fragility and could be disadvantaged by microinjection-related trauma.…”

“…A study on patients aged 25-40, with ovarian endometriosis, showed that although the fertilization rate was higher inseminating sibling oocytes by ICSI with normal semen than using cIVF, the ongoing pregnancy rate after ICSI was unusually low (15.6%), suggesting induced mechanical oocyte damage [11]. Moreover, recent research by Tan et al retrospectively compared the outcome of cIVF vs. ICSI in women with endometriosis at various stages: patients with the disease at Stage 3 and 4 (including those with endometrioma) submitted to ICSI with normal semen obtained a significantly lower pregnancy and live birth rate than those undergoing cIVF [12], suggesting that the oocytes of these patients could be peculiarly fragile and could have been harmed by microinjection. The study by Tan et al excluded couples with a severe male factor, which are commonly found in the clinical practice and are "forced" to receive ICSI; as it is known that semen quality affects ICSI results [13], it could be argued that if ICSI would have been performed using pathological semen, the advantage of cIVF over ICSI could have resulted to be even higher.…”