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Human Reproduction, Vol. 15, No. 6, 1278-1283, June 2000
© 2000 European Society of Human Reproduction and Embryology

Should ICSI be the treatment of choice for all cases of in-vitro conception?

Simon Fishel1,4, Irfan Aslam1, Franco Lisi2, Leonardo Rinaldi2, Judy Timson1, Merwyn Jacobson3, Lawrence Gobetz3, Steve Green1, Alison Campbell1 and Rosella Lisi2

1 CARE (Centres for Assisted Reproduction) at The Park Hospital, Sherwood Lodge Drive, Burntstump Country Park, Arnold, Nottingham, NG5 8RX, United Kingdom, 2 Biogenesi, Casa di Cura, Villa Europa, Via Eufrate 27, 00144 Rome, Italy and 3 Vitalab, Box 46337 Orange Grove, 2119 Republic of South Africa

The objective of this study was to examine different clinical scenarios of in-vitro conception, viz. fertilization with conventional IVF, IVF with high insemination concentration (HIC) and intracytoplasmic sperm injection (ICSI), and assess on a sibling oocyte comparison the hypothesis that ICSI should be performed in all cases requiring in-vitro conception. ICSI with husband's spermatozoa had a higher incidence of fertilization as compared with IVF or IVF with HIC with donor spermatozoa (if previous failure of fertilization had occurred) for unexplained infertility. Similarly, ICSI with husband's spermatozoa had as high an incidence of fertilization as IVF with donor spermatozoa for patients with severe oligozoospermia, asthenozoospermia and/or teratozoospermia, even when the spermatozoa were not selected for their morphology. Two studies were performed to assess ICSI in potential oocyte-related failure of IVF, viz. when fertilization occurred in >50% of oocytes for one group of patients, and in <50% of oocytes in a second group. In both of these studies a significant proportion of the oocytes that failed to fertilize with conventional IVF eventually fertilized after ICSI. The overall conclusion was that ICSI as a first option offers a higher incidence of fertilization, maximizes the number of embryos and minimizes the risk of complete failure of fertilization for all cases requiring in-vitro conception. However, among other concerns, current knowledge of ICSI as an outcome procedure does not provide the confidence to use this process in all cases of IVF for the time being.

Key words: assisted conception/ICSI/infertility/IVF/micro-injection

4 To whom communication should be addressed


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