Male Infertility Procedure Up, but Not Birth Rate

Intracytoplasmic sperm injection not linked to better birth outcomes than in vitro fertilization

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) For many men who are infertile, a procedure called intracytoplasmic sperm injection (ICSI) offers a way to have a child. While more couples are using this method, it may not improve upon the more common in vitro fertilization.

A new study from the Centers for Disease Control and Prevention (CDC) has found that the use of ICSI doubled over 16 years but did not lead to more pregnancies and births compared to in vitro fertilization. The authors of this study also noted that the procedure is significantly more expensive and may heighten the risk of passing genetic defects on to the embryo.

This research was conducted by Sheree L. Boulet, DrPH, a health scientist in the Division of Reproductive Health at the CDC in Atlanta, and colleagues.

“We concluded that ICSI does improve fertilization in the context of male factor infertility," Dr. Boulet told dailyRx News. "However, our study also showed that reproductive outcomes beyond fertilization — implantation, pregnancy, miscarriage, and live birth — were not improved when ICSI was used, regardless of whether male factor infertility was present or not.”

The technique of fertilizing an egg with a single sperm is called intracytoplasmic sperm injection (ICSI). With more conventional in vitro fertilization (IVF), many sperm are placed near an egg to fertilize it. ICSI is commonly used among couples facing male infertility issues.

Dr. Boulet and team analyzed data on nearly 1.4 million fresh IVF cycles from 1996 to 2012. An IVF cycle is the lab fertilization of eggs that are retrieved when they mature.

Of these patients, almost two-thirds used ICSI (pronounced “ICK-see”), while the remainder used conventional IVF. Just over one-third reported having male factor infertility. Male infertility may be very low sperm count, abnormal semen characteristics, abnormal sperm function or surgical sterilization.

During the time frame of this research, ICSI use rose from 36.4 percent to 76.2 percent.

Dr. Boulet and team noted that ICSI use increased among both those with male factor infertility and those without male infertility. While it rose from about 76 percent to 93 percent of those with male factor infertility, its use jumped from about 15 percent to 67 percent for those without male factor infertility.

Compared to patients who underwent IVF, patients who opted for ICSI had lower rates of implantation (23 percent for ICSI vs. 25 percent for IVF), live birth (36 vs. 39 percent) and multiple live birth (30 vs. 31 percent).

Dr. Boulet and team also wrote that ICSI bypasses natural barriers to fertilization, which may increase the risk of transmitting genetic defects compared to conventional IVF.

ICSI also cost more than conventional IVF, adding significant financial burden for many couples, these researchers noted. The American Society of Reproductive Medicine lists the average price of an IVF cycle in the US at $12,400. ICSI may cost $1,500 more than that or higher.

This study was published Jan. 20 in JAMA.

The National Center for Advancing Translational Sciences funded this research. The authors disclosed no conflicts of interest.

Review Date: 
January 22, 2015
Last Updated:
January 26, 2015