Who is most likely to benefit from ICSI?

A review of research by a team of American experts has shed more light on who is likely or unlikely to benefit from ICSI – a technique commonly used in Australian fertility clinics.

Intracytoplasmic sperm injection (ICSI) was developed in the early 1990s to help couples where the male had poor sperm quality. It’s similar to IVF except that instead of adding thousands of sperm to each egg and waiting for one to fertilise the egg, the scientist uses special equipment to pick up a single sperm in a pipette and inject one into each egg. Because it requires special equipment and trained scientists, it costs about $500-$800 more than standard IVF (once Medicare rebates have been taken into account).

While ICSI has increased the chance of a live birth for couples where the man has been diagnosed with infertility, there has been a global trend towards clinics using ICSI for other people too. The latest national data for Australia shows that in 2017, 62 per cent of embryo transfers involved an embryo created with ICSI. This occurred when fewer than 40 per cent of couples have a diagnosis of male infertility.

The trend has been controversial among fertility specialists and scientists because of the additional cost of ICSI for patients, and studies showing that babies born following ICSI have a slightly higher risk of birth defects compared to babies created following IVF. While there is no proof that ICSI causes birth defects, there is some concern that there is no natural process for sperm selection when a single sperm is selected and injected straight into the egg.

So is ICSI worth using if you don’t have a diagnosis of male infertility? A review of the available research on ICSI by the American Society for Reproductive Medicine this month concluded that “in cases without male factor infertility or a history of prior fertilisation failure, the routine use of ICSI for all oocytes (eggs) is not supported by the available evidence”.

The authors said that the only other groups it may benefit are:

  • People having preimplantation genetic testing to prevent passing on monogenic diseases such as Cystic Fibrosis or Huntington disease, and
  • People using eggs that were previously frozen.

The review also concluded that ICSI does not improve the chance of a baby for:

  • Women with a low egg yield
  • Women aged 35 and over
  • People with unexplained infertility.

The review found that while ICSI increases the chance of eggs fertilising for these groups, that does not translate into a higher chance of having a baby.

You can read more about the risks and benefits of ICSI here.

Source: ASRM, Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion. Fertility and Sterility, 2020.