IVF vs ICSI: which is more successful procedure for older women with infertility?

This study investigated in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in to treat infertility in women over the age of 40.

This study found that IVF resulted in higher rates of implantation and adjusted live-birth compared to ICSI.

Infertility is treated by using one or more assisted reproductive technologies (ART). In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are two ARTs used to fertilize an egg prior to implantation.

Advanced age is a limiting factor to the success of fertility treatment. Prior to IVF or ICSI, oocytes (eggs) are retrieved from the woman. Women of advanced age typically have a lower number of oocytes retrieved. As the number of oocytes are fewer, some doctors prefer to use ICSI as it has a greater success rate of fertilization compared to conventional IVF, in general. However, it is unknown whether IVF or ICSI is more successful in achieving pregnancy in women over the age of 40 seeking fertility treatment.  

This study investigated the fertility success rates of IVF and ICSI in women over the age of 40 seeking fertility treatment.

This study included 644 female patients between the age of 40 and 43, undergoing fertility treatment. These patients all underwent a short protocol of ovarian hypertimulation to retrieve oocytes, and no more than 5 oocytes were retrieved. Following this, patients underwent either IVF or ICSI. Pregnancy was confirmed at 7 weeks and miscarriage was defined as pregnancy loss before 28 weeks gestation (pregnancy). Patients were monitored as per standard pregnancy care and outcomes were recorded.

Fertilization rates were similar in both IVF and ICSI-treated patients. Fertilization rates were higher in the ICSI group (61.56%) versus IVF (76%) in the case of patients where the male partner had normal sperm. Implantation rates were higher in the IVF group (15.11%) compared to ICSI (7.75%). When the live-birth rate was adjusted to account for a number of factors including age, primary infertility (has never become pregnant) and oocyte number, IVF was more successful (14.59%) than ICSI (5.56%). 

This study concluded that IVF resulted in higher rates of implantation and adjusted live-birth compared to ICSI.

A higher proportion of patients underwent IVF compared to ICSI (534 vs. 110). This study was retrospective, so the strategies for treatment will have differed between patients. This could have impacted the results, a controlled-trial would be beneficial. 

If you have any concerns regarding fertility treatment or assisted reproductive technologies please discuss with your physician.