P-132 Does intracytoplasmic injection (ICSI) improve the outcome of ART (Assisted Reproductive Technologies) cycles in non-male factor infertility cases compared to conventional in-vitro fertilisation (IVF)?
Authors: Jussubaliyeva T , Bekzatova K , Shishimorova M 
Published: June 2022

Abstract

Study question
The aim of this study is to analyse the efficiency of IVF and ICSI cycles in non-male factor infertility cases according to the female age.

Summary answer
There were no statistical differences in clinical pregnancy rate, implantation rate and live birth rate found between ICSI and IVF in both age groups.

What is known already
ICSI was introduced to ART clinical routine in 1992 to treat couples with male factor infertility. According to the international reports, in 2017 use of ICSI opposed to IVF reached 69.3% globally, fluctuating in regions between 62.1% up-to 90.1%. There was ongoing debate whether to use the ICSI in non-male factor cycles: a number of clinics prefer ICSI to avoid total fertilisation failure (TFF), however there are studies (2020) that suggest the method of fertilisation does not affect the results. In contrast, there are research works that claim that IVF improves the clinical results in cycles with non-male factors.

Study design, size, duration
The retrospective analysis included 2505 cycles that were performed from 2012 to 2018. All selected patients were diagnosed with non-male factor infertility and underwent ART cycle in the Institute of Reproductive Medicine. The cycles with mixed insemination IVF/ICSI were uxcluded as well as cycles with preimplantation genetic testing for aneuploidy, previously failed IVF, freezed oocytes and/or other ICSI indications. Frozen embryo transfers were excluded and fresh transfers were performed on a Day 5.

Participants/materials, setting, methods
The selection of cycles were divided into main two groups IVF (n = 1693) and ICSI (n = 812). Due to the infuence of age the studied group were further divided by female age: &lt;35 and &gt;35; Fertilisation rate and abnormal fertilisation rate of inseminated oocytes, embryo transfer cancelation rate due to the quality or abcense of blastocyst, implantation rate, clinical pregnacy rate, live birth rate were considered as main efficency indicators. The results were analysed by Student's t-test.

Main results and the role of chance
There was a significant statistical difference (P &lt; 0.0001) in fertilisation rate between the methods in females &lt;35 (IVF - 68.43% and ICSI - 82.36% ). Same results were among females &gt;35 (P &lt; 0.0001, IVF - 67.68% and ICSI - 80.7%). However, the clinical pregnancy rate didn’t differ substantially (p &gt; 0,05) in both age groups (&lt;35: 50.62% vs. 46.02% and &gt;35: 43.05% vs 44.1% in IVF vs. ICSI, respectively). Moreover, there was no notable difference in live birth rate (p &gt; 0.05) in either age groups (&lt;35: 32.54% vs. 33.62% and &gt;35: 24.88% vs. 28.31% in IVF vs ICSI, respectively). Implantation rate between fertilisation methods demonstrated comparable results (p &gt; 0.05, &lt;35: 34.18% vs. 33.97% and &gt;35: 27.02% vs. 27.72% in IVF vs ICSI, respectively). It’s important to note that IVF had a considerably higher abnormal fertilisation rate (P &lt; 0.0001, &lt;35: 9.25% vs. 2.5% and &gt;35: 8.92% vs. 2.43% in IVF vs ICSI, respectively). Nonetheless, the cancellation rate was remarkably higher (p &lt; 0.05) in ICSI among females &lt;35 (4.23% vs. 7.72% in IVF vs ICSI, respectively). There was no statistical difference in cancelation rate in &gt; 35 age group (11.35% vs. 14.55% in IVF vs. ICSI, respectively; p &gt; 0.05).

Limitations, reasons for caution
Due to the retrospective nature of the study, there were limitations that substantially decreased the selection of available patients. Also it’s important to note that group IVF was significantly larger than group ICSI.

Wider implications of the findings
Shift towards the IVF as the fertilisation method of choice in non-male factor cycles could potentially decrease the cost of ART treatment for patients, as well as facilitate laboratory processes for embryologists. In view of the fact that an overworked environment can potentially increase the risk of human factor mistakes.

Trial registration number
n/a