IVF vs. ICSI: which is more appropriate in men with abnormal sperm morphology?

This study investigated assisted reproductive techniques (ART) in men with abnormal sperm morphology (ASM). They found that in vitro fertilization (IVF) is more effective in men with mild or moderate ASM.

Assisted reproductive techniques (ART) are used to treat infertility. In vitro fertilization (IVF) is an ART. It involves placing an egg (oocyte) and sperm in a dish. Sperm swim towards the oocyte and fertilize it. Intracytoplasmic sperm injection (ICSI) is another ART. ICSI involves injecting sperm into the oocyte.

ICSI is often used when men have abnormal sperm morphology (ASM; abnormal shape). The definition of ASM is controversial. 4% is the threshold for ASM. ASM can be confirmed if 4% of sperm are abnormal. Older guidelines had a cut-off of 14% for ASM. Rating sperm morphology (SM) can be difficult and subjective. This means it can vary. Some doctors believe using SM thresholds can limit ART options. Men with ASM may have normal sperm concentration (SCC) and motility (movement). IVF may be suitable for some men with ASM. It is unclear if IVF or ICSI is more successful in men with ASM.

This study included 51 couples. The men had mild to moderate ASM. Oocytes were harvested. Each couple had oocytes that underwent either IVF or ICSI. Clinical outcomes were compared. These included fertilization rate (FR), embryo quality (EQ) and pregnancy rate (PR). 

FR was similar in IVF- (58.2%) and ICSI-fertilized (54.5%) embryos. EQ was similar in the early stages of development. More oocytes died after ICSI (11.7%) vs. IVF (4.3%). More embryos developed into blastocysts after IVF. This suggests a higher quality. PR was similar in both groups.

They concluded that IVF is more effective in men with mild to moderate ASM compared to ICSI.

The number of couples in this study was low. Larger studies are needed to confirm these findings.

If you have any concerns regarding infertility please consult with your physician.