E Bosch1, J J Espinós2,3, F Fabregues4, J Fontes5, J García-Velasco6, J Llácer7, A Requena6, M A Checa8, J Bellver9,10. 1. IVI RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain. Ernesto.Bosch@ivirma.com. 2. Fertty, Ausiàs March 25, 08010, Barcelona, Spain. 3. Universidad Autónoma de Barcelona, Campus de la UAB, Plaza Cívica, s/n, 08193, Bellaterra (Barcelona), Spain. 4. Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, C/Villarroel 160, 08036, Barcelona, Spain. 5. Hospital Universitario Virgen de las Nieves, Avd Fuerzas Armadas s/n, 18014, Granada, Spain. 6. IVI RMA Madrid, Avda. del Talgo 68, 28023, Madrid, Spain. 7. Instituto Bernabeu Alicante, Av. Albufereta, 31, 03540, Alacant (Alicante), Spain. 8. Hospital del Mar-Parc de Salut Mar, Paseo Maritimo 25-29, 08005, Barcelona, Spain. 9. IVI RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain. 10. Departamento de Pediatría, Obstetricia y Ginecología. Facultad de Medicina, Universidad de Valencia, Valencia, Spain.
Abstract
PURPOSE: Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. METHODS: A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. RESULTS: The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. CONCLUSION: Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.
PURPOSE: Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. METHODS: A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. RESULTS: The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. CONCLUSION: Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.
Entities:
Keywords:
Assisted reproduction; In vitro fertilization (IVF); Infertility; Intracytoplasmic sperm injection (ICSI); Pregnancy; Severe non-male factor
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