Is ICSI or IVF better for couples with non-male cause infertility?

This study looked at the effect of using intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) for couples where the woman was over 35 and the man had normal sperm quality. It found that standard IVF led to more births than ICSI.

IVF is an infertility treatment in which medications stimulate the ovaries, and the eggs (oocytes) are removed and fertilized in the laboratory. Then, the embryos are implanted in the uterus. IVF has a higher success rate when there are more embryos. Unsuccessful fertilization can reduce the effectiveness of IVF, particularly when there is a low sperm count or quality. 

For couples with male infertility, using ICSI improves outcomes. ICSI is a form of IVF in which a single sperm is injected into the oocyte (egg). However, ICSI has increasingly been used for couples with normal sperm quality. This is particularly true when the woman’s tests or age indicate there will be few oocytes available. Despite the common practice to use ICSI, it is not clear whether ICSI or IVF benefits these couples.

This study used records from 577 couples with infertility who underwent assisted reproduction. 25% of couples used standard IVF, and 75% used ICSI. None of the couples used genetic testing (which typically uses ICSI). The most common diagnosis was unexplained infertility. All of the women were over age 35, although the ICSI group had more women over age 40. All of the men had normal sperm quality, although the sperm quality was higher for couples using IVF.

The researchers used statistics to adjust for characteristics such as age and sperm quality. After adjustment, couples using IVF had significantly more pregnancies as confirmed by ultrasound (2.44 times higher odds). The IVF group were also significantly more likely to have a baby (2.26 times higher odds). 

However, the IVF group also had significantly more miscarriages (1.87 times higher odds).

This study found that IVF gave better results than ICSI for couples with female age over 35 and normal sperm quality.

The treatment was chosen by couples and their doctors based on their health history and personal circumstances. Additional studies are needed which randomly assign couples to IVF or ICSI.

If you are using assisted reproduction and there is normal sperm quality, talk to your doctor about standard IVF.