Use of ICSI on the rise, despite stable number of male-factor infertility cases

The use of intracytoplasmic sperm injection has increased dramatically in the United States since 1995, while the proportion of patients receiving treatment for male-factor infertility has remained stable, according to a study in the New England Journal of Medicine (2007; 357:251-7).

"Despite its added cost and uncertain efficacy and risk, the use of ICSI has been extended to include patients without documented male-factor infertility," said lead author Tarun Jain, MD, of the University of Illinois at Chicago.

The researchers analyzed national data on assisted reproductive technology from 1995 to 2004. The study included all in vitro fertilization cycles involving fresh embryos from non-donor eggs in women younger than 43 years.

"The percentage of IVF cycles that used ICSI increased dramatically during the 10-year time span, from 11% to 57.5%, while the percentage of diagnosis for male-factor infertility remained steady," Dr. Jain said.

Dr. Jain notes that some physicians may feel that ICSI is appropriate for patients who have failed prior IVF cycles, for patients who have very few eggs available, or to overcome barriers to the normal fertilization process.

"Further studies are needed to better understand the proper role of ICSI, and perhaps guidelines may be useful to determine what the best indications are for use of the technology in patients without male-factor infertility," Dr. Jain said.