Skip to main content
SpringerLink
Log in

The role of ICSI vs. conventional IVF for patients with advanced maternal age—a randomized controlled trial

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to evaluate the role of intracytoplasmic sperm injection (ICSI) in the treatment of non-male factor infertile patients aged ≥ 39.

Methods

This is a single-center, prospective, randomized controlled clinical trial, between March 2018 and December 2019. Sixty-nine patients were recruited, and sixty patients participated in the study. Their ovaries were randomized prior to the beginning of the ovarian stimulation: the oocytes from one side (n = 257) were allocated to the ICSI (ICSI arm), while those of the contralateral side (n = 258) were allocated to conventional insemination (IVF arm). The fertilization rate per oocyte retrieved, number of zygotes (2PN), and cleavage-stage embryos were assessed and compared between the two study groups.

Results

The average number of zygotes (3.1 vs. 2.7 p = 0.45), the fertilization rate (72.4% vs. 65.1% p = 0.38), the average number of cleavage-stage (2.8 vs. 2.4 p = 0.29), and the average top-quality embryos (TQE) cleavage-stage embryos (1.7 vs. 1.6 p = 0.94) were comparable between the two groups. The TQE rate per randomized oocyte (41.2% vs. 41% p = 0.8) was also similar in both groups.

Conclusions

ICSI does not improve the reproductive outcomes of advanced-age patients undergoing conventional insemination for non-male factor infertility.

Trial registration

NCT03370068

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Boulet SL, Mehta A, Kissin DM, Warner L, Kawwass JF, Jamieson DJ. Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection. JAMA. 2015;313(3):255–63.

    Article  PubMed  Google Scholar 

  2. Dyer S, Chambers GM, de Mouzon J, Nygren KG, Zegers-Hochschild F, Mansour R, et al. International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2008, 2009 and 2010. Hum Reprod. 2016;31(7):1588–609.

    Article  CAS  PubMed  Google Scholar 

  3. Bhattacharya S, Hamilton MPR, Shaaban M, Khalaf Y, Seddler M, Ghobara T, et al. Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial. Lancet. 2001;357(9274):2075–9.

    Article  CAS  PubMed  Google Scholar 

  4. De Munck N, et al. Intracytoplasmic sperm injection is not superior to conventional IVF in couples with non-male factor infertility and preimplantation genetic testing for aneuploidies (PGT-A). Hum Reprod. 2020;35(2):317–27.

    Article  PubMed  Google Scholar 

  5. Aboulghar MA, Mansour RT, Serour GI, Sattar MA, Amin YM. Intracytoplasmic sperm injection and conventional in vitro fertilization for sibling oocytes in cases of unexplained infertility and borderline semen. J Assist Reprod Genet. 1996;13(1):38–42.

    Article  CAS  PubMed  Google Scholar 

  6. Ruiz A, Remohí J, Minguez Y, Guanes PP, Simón C, Pellicer A. The role of in vitro fertilization and intracytoplasmic sperm injection in couples with unexplained infertility after failed intrauterine insemination. Fertil Steril. 1997;68(1):171–3.

    Article  CAS  PubMed  Google Scholar 

  7. Tournaye H, Verheyen G, Albano C, Camus M, van Landuyt L, Devroey P, et al. Intracytoplasmic sperm injection versus in vitro fertilization: a randomized controlled trial and a meta-analysis of the literature. Fertil Steril. 2002;78(5):1030–7.

    Article  PubMed  Google Scholar 

  8. Davies MJ, Moore VM, Willson KJ, van Essen P, Priest K, Scott H, et al. Reproductive technologies and the risk of birth defects. N Engl J Med. 2012;366(19):1803–13.

    Article  CAS  PubMed  Google Scholar 

  9. Maman E, Geva LL, Yerushalmi G, Baum M, Dor J, Hourvitz A. ICSI increases ongoing pregnancy rates in patients with poor response cycle: multivariate analysis of 2819 cycles. Reprod BioMed Online. 2012;25(6):635–41.

    Article  PubMed  Google Scholar 

  10. Farhi J, Cohen K, Mizrachi Y, Weissman A, Raziel A, Orvieto R. Should ICSI be implemented during IVF to all advanced-age patients with non-male factor subfertility? Reprod Biol Endocrinol. 2019;17(1):30.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tannus S, Son WY, Gilman A, Younes G, Shavit T, Dahan MH. The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age. Hum Reprod. 2017;32(1):119–24.

    PubMed  Google Scholar 

  12. Bar-Hava I, Orvieto R, Ferber A, Ashkenazi J, Dicker D, Ben-Rafael Z. Standard in vitro fertilization or intracytoplasmic sperm injection in advanced female age--what may be expected? Gynecol Endocrinol. 1999;13(2):93–7.

    Article  CAS  PubMed  Google Scholar 

  13. Ziebe S, Lundin K, Janssens R, Helmgaard L, Arce JC, for the MERIT (Menotrophin vs Recombinant FSH in vitro Fertilisation Trial) Group. Influence of ovarian stimulation with HP-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF. Hum Reprod. 2007;22(9):2404–13.

    Article  CAS  PubMed  Google Scholar 

  14. Kilani SS, Cooke S, Kan AK, Chapman MG. Do age and extended culture affect the architecture of the zona pellucida of human oocytes and embryos? Zygote. 2006;14(1):39–44.

    Article  PubMed  Google Scholar 

  15. Bertrand E, Van den Bergh M, Englert Y. Does zona pellucida thickness influence the fertilization rate? Hum Reprod. 1995;10(5):1189–93.

    Article  CAS  PubMed  Google Scholar 

  16. Sunderam S, Boulet SL, Kawwass JF, Kissin DM. Comparing fertilization rates from intracytoplasmic sperm injection to conventional in vitro fertilization among women of advanced age with non-male factor infertility: a meta-analysis. Fertil Steril. 2020;113(2):354–63 e1.

    Article  PubMed  Google Scholar 

  17. Batsry L, Orvieto R, Mor-Hadar D, Yung Y, Gitman H, Shimon C, et al. Can we predict oocyte maturation prior to denudation for intracytoplasmic sperm injection? Gynecol Endocrinol. 2020;36(3):265–7.

    Article  PubMed  Google Scholar 

  18. Haas J, Meriano J, Bassil R, Barzilay E, Casper RF. What is the optimal timing of embryo transfer when there are only one or two embryos at cleavage stage? Gynecol Endocrinol. 2019;35(8):665–8.

    Article  PubMed  Google Scholar 

  19. Racowsky C, Jackson KV, Cekleniak NA, Fox JH, Hornstein MD, Ginsburg ES. The number of eight-cell embryos is a key determinant for selecting day 3 or day 5 transfer. Fertil Steril. 2000;73(3):558–64.

    Article  CAS  PubMed  Google Scholar 

  20. Xiao JS, Healey M, Talmor A, Vollenhoven B. When only one embryo is available, is it better to transfer on day 3 or to grow on? Reprod BioMed Online. 2019;39(6):916–23.

    Article  PubMed  Google Scholar 

  21. Lee SH, Lee JH, Park YS, Yang KM, Lim CK. Comparison of clinical outcomes between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in IVF-ICSI split insemination cycles. Clin Exp Reprod Med. 2017;44(2):96–104.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, 52620, Tel-Hashomer, Israel

    Jigal Haas, Tal Elkan Miller, Ravit Nahum, Adva Aizer, Michal Kirshenbaum, Eran Zilberberg, Oshrit Lebovitz & Raoul Orvieto

  2. Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel

    Jigal Haas, Tal Elkan Miller, Ravit Nahum, Adva Aizer, Michal Kirshenbaum, Eran Zilberberg, Oshrit Lebovitz & Raoul Orvieto

Authors
  1. Jigal Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tal Elkan Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ravit Nahum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adva Aizer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michal Kirshenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eran Zilberberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Oshrit Lebovitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Raoul Orvieto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jigal Haas.

Ethics declarations

The study was approved by our institutional review board (IRB), and all participants provided a written informed consent before entry.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Jigal Haas and Tal Elkan Miller are joint first authors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haas, J., Miller, T.E., Nahum, R. et al. The role of ICSI vs. conventional IVF for patients with advanced maternal age—a randomized controlled trial. J Assist Reprod Genet 38, 95–100 (2021). https://doi.org/10.1007/s10815-020-01990-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-020-01990-5

Keywords

Search

Navigation