Skip to main content
SpringerLink
Log in

Comparison of ICSI and conventional IVF in non-male factor patients with less than four oocytes

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

We aimed to analyse our clinical results for a particular subgroup of patients with poor ovarian response (POR) to clarify if lower number of oocytes is a drawback for proceeding to C-IVF.

Materials and methods

In this retrospective study, patient files of all couples (#1733) who underwent oocyte retrieval between January 2017 and December 2019 were reviewed and 191 cases diagnosed with non-male factor infertility in which ≤ 3 cumulus–oocyte complexes available for fertilisation were analysed. Exclusion criteria were: woman age > 42, patients with a history of previous ART trial, prenatal genetic testing cycles and couples undergoing total cryopreservation for any indication. Three groups were constructed depending on the method of fertilisation and on semen quality as follows: IVF non-male factor (Group 1, n = 77); ICSI non-male factor (Group 2, n = 65); ICSI male factor-ICSI/MF n = 49 according to WHO reference values. Main outcome parameters were: fertilisation rate, implantation rate and live birth rate.

Results

Fertilisation rate per collected COC was significantly higher in group 1 compared to the other two groups (85.68%, 72.58%, 73.33% respectively, p = 0.004). FR per inseminated oocyte also tended to be higher in group 1 but not reaching a statistically significant level. Both techniques yielded similar implantation rates (20.42%, 28.49%, 23.33% respectively, p = 0.407) and live birth rates (26.8%, 30.6%, 31.1%, respectively, p = 0.643).

Conclusion

In the presence of normal semen parameters, low egg number is not an indication to perform ICSI. The choice of fertilisation method should be based primarily on semen quality, in combination with the patient’s previous history regardless of the ovarian reserve.

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

Similar content being viewed by others

References

  1. Steptoe PC and Edwards RG (1978) Birth after the reimplantation of a human embryo. Lancet 12;2(8085):366. https://doi.org/10.1016/s0140-6736(78)92957-4.

  2. Niederberger C, Pellicer A, Cohen J, Gardner DK, Palermo GD, O'Neill CL, Chow S, Rosenwaks Z, Cobo A, Swain JE, Schoolcraft WB, Frydman R, Bishop LA, Aharon D, Gordon C, New E, Decherney A, Tan SL, Paulson RJ, Goldfarb JM, Brännström M, Donnez J, Silber S, Dolmans MM, Simpson JL, Handyside AH, Munné S, Eguizabal C, Montserrat N, Izpisua Belmonte JC, Trounson A, Simon C, Tulandi T, Giudice LC, Norman RJ, Hsueh AJ, Sun Y, Laufer N, Kochman R, Eldar-Geva T, Lunenfeld B, Ezcurra D, D'Hooghe T, Fauser BCJM, Tarlatzis BC, Meldrum DR, Casper RF, Fatemi HM, Devroey P, Galliano D, Wikland M, Sigman M, Schoor RA, Goldstein M, Lipshultz LI, Schlegel PN, Hussein A, Oates RD, Brannigan RE, Ross HE, Pennings G, Klock SC, Brown S, Van Steirteghem A, Rebar RW and LaBarbera AR (2018) Forty Years of IVF. Fertil Steril 15;110(2):185–324.e5. https://doi.org/10.1016/j.fertnstert.2018.06.005.

  3. Palermo G, Joris H, Devroey P, Van Steirteghem AC (1992) Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 340(8810):17–18

    Article  CAS  Google Scholar 

  4. ESHRE Focus on Reproduction September 2016 https://www.eshre.eu/Publications/Focus-on-Reproduction/Focus-in-2016

  5. Boulet SL, Mehta A, Kissin DM, Warner L, Kawwass JF, Jamieson DJ (2015) Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection. JAMA 313(3):255–263. https://doi.org/10.1001/jama.2014.17985

    Article  PubMed  Google Scholar 

  6. Orief Y, Dafopoulos K (2004) Al-Hassani S Should ICSI be used in non-male factor infertility? Reprod Biomed Online 9(3):348–356. https://doi.org/10.1016/s1472-6483(10)62152-9

    Article  PubMed  Google Scholar 

  7. O'Neill CL, Chow S, Rosenwaks Z, Palermo GD. Development of ICSI. Reproduction. 2018 Jul;156(1):F51-F58. https://doi.org/10.1530/REP-18-0011. Epub 2018 Apr 10. Review

  8. Gjerris AC, Loft A, Pinborg A, Christiansen M, Tabor A (2008) Prenatal testing among women pregnant after assisted reproductive techniques in Denmark 1995–2000: a national cohort study. Hum Reprod 23(7):1545–1552. https://doi.org/10.1093/humrep/den103 (Epub 2008 Apr 1)

    Article  CAS  PubMed  Google Scholar 

  9. Kohda T, Ishino F (2013) Embryo manipulation via assisted reproductive technology and epigenetic asymmetry in mammalian early development. Philos Trans R Soc Lond B Biol Sci 368(1609):20120353. https://doi.org/10.1098/rstb.2012.0353.Review

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kissin DM, Zhang Y, Boulet SL, Fountain C, Bearman P, Schieve L, Yeargin-Allsopp M, Jamieson DJ (2015) Association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children. Hum Reprod 30(2):454–465. https://doi.org/10.1093/humrep/deu338 (Epub 2014 Dec 17)

    Article  CAS  PubMed  Google Scholar 

  11. Sandin S, Nygren KG, Iliadou A, Hultman CM, Reichenberg A (2013) Autism and mental retardation among offspring born after in vitro fertilisation. JAMA 310(1):75–84. https://doi.org/10.1001/jama.2013.7222

    Article  CAS  PubMed  Google Scholar 

  12. Davies MJ, Rumbold AR, Marino JL, Willson K, Giles LC, Whitrow MJ, Scheil W, Moran LJ, Thompson JG, Lane M, Moore VM (2017) Maternal factors and the risk of birth defects after IVF and ICSI: a whole of population cohort study. BJOG 124(10):1537–1544. https://doi.org/10.1111/1471-0528.14365 (Epub 2016 Oct 17)

    Article  CAS  PubMed  Google Scholar 

  13. Isikoglu M, Avci A, Kendirci Ceviren A, Aydinuraz A, Ata B Conventional IVF revisited: Is ICSI better for non-male factor infertility? Randomized controlled double blind study J Gynecol Obstet Hum Reprod. 2020 Nov 19;101990. https://doi.org/10.1016/j.jogoh.2020.101990. Online ahead of print.

  14. Balaban B, Urman B, Isiklar A, Alatas C, Aksoy S, Mercan R, Mumcu A, Nuhoglu A (2001) The effect of pronuclear morphology on embryo quality parameters and blastocyst transfer outcome. Hum Reprod 16(11):2357–2361. https://doi.org/10.1093/humrep/16.11.2357

    Article  CAS  PubMed  Google Scholar 

  15. Dyer S, Chambers GM, de Mouzon J, Nygren KG, Zegers-Hochschild F, Mansour R, Ishihara O, Banker M, Adamson GD (2016) International committee for monitoring assisted reproductive technologies world report: assisted reproductive technology 2008, 2009 and 2010. Hum Reprod 31(7):1588–1609. https://doi.org/10.1093/humrep/dew082 (Epub 2016 May 20)

    Article  CAS  PubMed  Google Scholar 

  16. ASRM, Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Intracytoplasmic sperm injection (ICSI) for non-male factor indications: a committee opinion. Fertil Steril. 2020 Aug;114(2):239–245. doi: https://doi.org/10.1016/j.fertnstert.2020.05.032. Epub 2020 Jul 9. PMID: 32654822.ASRM 2012

  17. Good Clinical Treatment in Assisted Reproduction ‐ An ESHRE position paper https://www.eshre.eu/Guidelines-and-Legal/ESHRE-Position-Papers

  18. SART 2016. Society for Assisted Reproductive Technology. SART Clinic Summary Report 2013; www.sartcorsonline.com

  19. Geng T, Cheng L, Ge C, Zhang Y (2020) The effect of ICSI in infertility couples with non-male factor: a systematic review and meta-analysis. J Assist Reprod Genet 37(12):2929–2945. https://doi.org/10.1007/s10815-020-01970-9 (Epub 2020 Oct 19)

    Article  PubMed  PubMed Central  Google Scholar 

  20. Supramaniam PR, Granne I, Ohuma EO, Lim LN, McVeigh E, Venkatakrishnan R, Becker CM, Mittal M.ICSI does not improve reproductive outcomes in autologous ovarian response cycles with non-male factor subfertility. Hum Reprod. 2020 Mar 27;35(3):583–594. https://doi.org/10.1093/humrep/dez301.

  21. Drakopoulos P, Garcia-Velasco J, Bosch E, Blockeel C, de Vos M, Santos-Ribeiro S, Makrigiannakis A, Tournaye H, Polyzos NP. ICSI does not offer any benefit over conventional IVF across different ovarian response categories in non-male factor infertility: a European multicenter analysis. J Assist Reprod Genet. 2019 Oct;36(10):2067–2076. https://doi.org/10.1007/s10815-019-01563-1. Epub 2019 Aug 22. Erratum in: J Assist Reprod Genet. 2019 Oct 14

  22. Bhattacharya S, Hamilton MP, Shaaban M, Kalaf Y, Seddler M, Ghobara T, Braude P, Kennedy R, Rutherford A, Hartshorne G et al (2001) Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial. Lancet 357:2075–2079

    Article  CAS  Google Scholar 

  23. Gennarelli G, Carosso A, Canosa S, Filippini C, Cesarano S, Scarafia C, Brunod N, Revelli A, Benedetto C (2019) ICSI versus conventional IVF in women aged 40 years or more and unexplained infertility: a retrospective evaluation of 685 cycles with propensity score model. J Clin Med 8(10):1694. https://doi.org/10.3390/jcm8101694

    Article  CAS  PubMed Central  Google Scholar 

  24. Kim JY, Kim JH, Jee BC, Lee JR, Suh CS (2014) Kim SH Can intracytoplasmic sperm injection prevent total fertilisation failure and enhance embryo quality in patients with non-male factor infertility? Eur J Obstet Gynecol Reprod Biol 178:188–191. https://doi.org/10.1016/j.ejogrb.2014.03.044 (Epub 2014 Apr)

    Article  PubMed  Google Scholar 

  25. van Rumste MM, Evers JL, Farquhar CM (2004) ICSI versus conventional techniques for oocyte insemination during IVF in patients with non-male factor subfertility: a Cochrane review. Hum Reprod 19(2):223–227

    Article  Google Scholar 

  26. Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N (2018) E A Sullivan ICSI does not increase the cumulative live birth rate in non-male factor infertility. Hum Reprod 33(7):1322–1330. https://doi.org/10.1093/humrep/dey118

    Article  CAS  PubMed  Google Scholar 

  27. Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, Carson SA, Cisneros P, Steinkampf MP, Hill JA, Xu D (2001) Vogel DL, national cooperative reproductive medicine network sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 345(19):1388–1393. https://doi.org/10.1056/NEJMoa003005

    Article  CAS  PubMed  Google Scholar 

  28. ESHRE Guideline Group on Good Practice in IVF Labs; De los Santos MJ, Apter S, Coticchio G, Debrock S, Lundin K, Plancha CE, Prados F, Rienzi L, Verheyen G, Woodward B, Vermeulen N Revised guidelines for good practice in IVF laboratories (2015) Hum Reprod . 2016 Apr;31(4):685–6. doi: https://doi.org/10.1093/humrep/dew016. Epub 2016 Feb 17

  29. ESHRE Special Interest Group of Embryology and Alpha Scientists in Reproductive Medicine The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators Reprod Biomed Online. 2017 Nov;35(5):494–510. https://doi.org/10.1016/j.rbmo.2017.06.015. Epub 2017 Aug 4.

  30. Tsirigotis M, Nicholson N, Taranissi M, Bennett V, Pelekanos M & Craft I 1995 Late intracytoplasmic sperminjection in unexpected failed fertilisation in vitro: diagnostic or therapeutic? Fertility and Sterility 63 816–819. (https://doi.org/10.1016/S0015-0282(16)57487-1

  31. Huang B, Qian K, Li Z, Yue J, Yang W, Zhu G, Zhang H (2015) Neonatal outcomes after early rescue intracytoplasmic sperm injection: an analysis of a 5-year period. Fertil Steril 103:1432.e1-1437.e1

    Google Scholar 

  32. Beck-Fruchter R, Lavee M, Weiss A, Geslevich Y, Shalev E (2014) Rescue intracytoplasmic sperm injection: a systematic review. Fertil Steril 101(3):690–698. https://doi.org/10.1016/j.fertnstert.2013.12.004 (Epub 2014 Jan 17)

    Article  PubMed  Google Scholar 

  33. Yuk JS, Kim M (2021) Incidence and prevalence of primary ovarian insufficiency in South Korea: a population-based study. Arch Gynecol Obstet 304:823–831. https://doi.org/10.1007/s00404-021-05962-7

    Article  CAS  PubMed  Google Scholar 

  34. Papamentzelopoulou M, Stavros S, Mavrogianni D et al (2021) Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols. Arch Gynecol Obstet 304:547–557. https://doi.org/10.1007/s00404-020-05954-z

    Article  CAS  PubMed  Google Scholar 

  35. Liu H, Zhao H, Yu G, Li M, Ma S, Zhang M, Wu K (2018) Conventional in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI): which is preferred for advanced age patients with five or fewer oocytes retrieved? Conventional in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI): which is preferred for advanced age patients with five or fewer oocytes retrieved? Arch Gynecol Obstet 297(5):1301–1306. https://doi.org/10.1007/s00404-018-4696-6 (Epub 2018 Feb 7)

    Article  PubMed  Google Scholar 

  36. Guo N, Hua X, Li Yu-F, Jin L Role of ICSI in non-male factor cycles as the number of oocytes retrieved decreases from four to one curr Med Sci . 2018;38(1):131-136. https://doi.org/10.1007/s11596-018-1856-7. Epub 2018 Mar 15

  37. Sfontouris IA, Kolibianakis EM, Lainas GT, Navaratnarajah R, Tarlatzis BC, Lainas TG (2015) Live birth rates using conventional in vitro fertilisation compared to intracytoplasmic sperm injection in Bologna poor responders with a single oocyte retrieved. J Assist Reprod Genet 32(5):691–697. https://doi.org/10.1007/s10815-015-0459-5 (Epub 2015 Mar 11)

    Article  PubMed  PubMed Central  Google Scholar 

  38. Tannus S, Son WY, Gilman A, Younes G, Shavit T, Dahan MH (2017) The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age. Hum Reprod 32(1):119–124 (Epub 2016 Nov 16)

    PubMed  Google Scholar 

  39. Grimstad FW, Nangia AK, Luke B, Stern JE, Mak W (2016) Use of ICSI in IVF cycles in women with tubal ligation does not improve pregnancy or live birth rates. Hum Reprod 31(12):2750–2755 (Epub 2016 Oct 13)

    Article  CAS  Google Scholar 

  40. C. Calhaz-Jorge, C. de Geyter, M.S. Kupka, J. de Mouzon, K. Erb, E. Mocanu, T. Motrenko, G. Scaravelli, C. Wyns, and V. Goossens Assisted reproductive technology in Europe, 2012: results generated from European registers by ESHRE Hum Rep 2016; 31, 1638–1652

Download references

Acknowledgements

Special thanks to Can Deniz Köksal for his courtesy of analysing data as well as critical review of the article from the statistical point of view. We are also grateful to Selenga Isikoglu for the English language edition of the manuscript.

Author information

Authors and Affiliations

  1. GELECEK The Center For Human Reproduction, Caglayan Mh Bulent Ecevit Bulvari No: 167, Lara, Antalya, Turkey

    Mete Isikoglu, Ayse Kendirci Ceviren, Tugba Cetin, Aysenur Avci & Batu Aydinuraz

  2. Department of Gynecology and Obstetrics, SBU Istanbul Bagcilar Training and Reseach Hospital, İstanbul, Turkey

    Ozlem Karabay Akgul

  3. Medical Park Hospital Department of Gynecology and Obstetrics, Antalya, Turkey

    Mehmet Karaca

Authors
  1. Mete Isikoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayse Kendirci Ceviren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tugba Cetin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aysenur Avci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Batu Aydinuraz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ozlem Karabay Akgul
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehmet Karaca
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MI have given substantial contributions to the conception or the design of the manuscript, AKC, TC and AA contributed to acquisition, analysis and interpretation of the data. All authors have participated to drafting the manuscript, MI revised it critically. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Mete Isikoglu.

Ethics declarations

Conflicts of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Isikoglu, M., Ceviren, A.K., Cetin, T. et al. Comparison of ICSI and conventional IVF in non-male factor patients with less than four oocytes. Arch Gynecol Obstet 306, 493–499 (2022). https://doi.org/10.1007/s00404-022-06471-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-022-06471-x

Keywords

Search

Navigation