In-vitro fertilization versus intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) has revolutionised the treatment of male-factor infertility. The technique provides new hope for many couples suffering from the most untreatable forms of male infertility. Results from the literature show that ICSI is a robust and highly predictive technique. The average reported normal. fertilisation rate per successfully injected metaphase-II oocyte is 60 % (confidence interval [CI] 45 % to 68 %) with an average cleavage rate reported of 78 %. In 91 % of the ICSI cycles embryos are replaced. The average clinical pregnancy rate reported is 27 % (CI 12% to 44 %). Only a few randomised controlled trials compared fertilisation after conventional IVF and ICSI for the treatment of moderate male-factor infertility, In all these studies sibling oocytes were randomly allocated to either treatment. After IVF, an average of 26 % of the oocytes were fertilised compared to an average of 58 % after ICSI, The odds in favour of fertilisation were four times higher after ICSI than after IVF (95 % CI 3.4 to 5.0, significant), The relative risk of fertilisation failure was 0.16 (95 % CI 0.08 to 0.32, significant) which means that the risk of fertilisation failure was six times lower after ICSI than after IVF, For ICSI, the clinical phase has completely preceded the research phase and many concerns have been raised. The follow-up data on children born after ICSI are still scarce and the oldest ICSI child is now 6 years old. In contrast data on the follow-up of NF children are vast and well documented Therefore IVF treatment should be preferred over ICSI as long as IVF can be an efficient alternative to the latter.