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Is there a reason to perform ICSI in the absence of male factor? Lessons from the Latin American Registry of ART
After correcting for age of female partner, number of oocytes inseminated, number of embryos transferred and transfer at blastocyst stage, we found that the use of ICSI was associated with a significant decrease in the odds of delivery compared to IVF (odds ratio 0.88, 95% CI 0.84 to 0.93: P < 0.0001).
204. Is there a reason to perform ICSI in the absence of male factor? [Forum/Discussion]
from: James Stanger (office@fertaid.com ), Australia on 12/09/2017 10:26:41 AM Profession:
Comment: The short answer is No. More Live births, fewer failed fertilisations and more blastocyst transfers.
Submission: Unless your clinic performs only ICSI as some do, this is a ongoing question. ICSI usually costs the clients more, consumes more scientists time and skills but means less day 1 time for fertilisation checks and denuding of coronal cells. Most would agree there should be limits but where does a clinic draw the line. The first point is that if there is a surcharge for providing ICSI then as the % ICSI cases increase, so does the clinics revenue. It is in the clinics interests that they each define the parameters for recommending ICSI and stick to it. A monthly KPI IVF:ICSI is a good way to keep a check on this. It is also a good question a client may like to ask their clinics doctors. // The second point is that this data suggests that recommending IVF over ICSI may be in the clients best interests, higher live birth rate, as long as there is no male factors present. The draw back here is what defines male factors. At first glance, a normal semen profile or previous good fertilisation may be a guide. If there is no previous conceptions or IVF attempts then one can never be entirely sure there is no underlying issues. Certainly a poor fertilisation in a previous cycle is a good reason even where the semen profile lies within the normal range. // Of course, IVF insemination but its nature is unpredictable and uncontrolled and many clients may elect to request ICSI to have greater certainty in getting embryos for transfer. One common situation is where there are few follicles or oocytes or where the female is older. It may be logical to think ICSI provides greater certainty to clients that everything that could be done has been done to ensure there are embryos for transfer. But the authors in this paper have explored both these scenarios and observed that IVF still delivers a better outcome than ICSI. The real problem occurs after an IVF attempt where there were few oocytes or the client was over 40 and there has been failure of fertilisation. Many scientists have been criticised by clinicians for not doing ICSI. The data does suggest that if IVF failed that so would have ICSI.// From a laboratory perspective, ICSI allows the clinic to document the incidence of oocyte maturity and injecting only the mature oocytes. This data reminds us that when oocytes reach maturity and receptivity for fertilisation is variable and IVF allows a better synchronicity between spermatozoa and oocyte. Whether oocytes with delayed maturation can achieve a pregnancy is not clear but it may be important. Another aspect of ICSI is the selection of an individual spermatozoon for the fertilisation of each oocyte. I have always been drawn to data investigating the amount of oocyte activation factors in sperm (PLCz) and the waves of Calcium release in the oocyte to future embryo development. One flaw with ICSI is that each scientist will select sperm for injection to largely their own criteria and therein lies a source of variability not found in IVF where the fertilising spermatozoon but definition must be of a minimal quality.//
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