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      Comparison of conventional IVF versus ICSI in non-male factor, normoresponder patients

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          Abstract

          Background: Conventional IVF and ICSI are two common techniques to achieve fertilization. IVF has long been used for treatment of infertility, although it is not an effective treatment in severe male infertility. The use of ICSI has been expanded in severe male factor and fertilization failure after IVF cycle. In spite of the widespread use of ICSI in patients with non-male factor infertility, there is still little evidence to confirm its effectiveness in this population.

          Objective: To evaluate assisted reproductive technology outcomes between IVF and ICSI cycles in non-male factor, normoresponder patients.

          Materials and Methods: A total of 220 non-male factors, normoresponder patients who were indicated for ART were enrolled in this study. The patients received standard long GnRH agonist or GnRH antagonist protocols for ovarian stimulation and after oocytes retrieval, the patients were divided into two groups (IVF and ICSI groups). In IVF group (n=112), all of retrieved oocytes were treated by conventional IVF and in ICSI group (n=88), microinjection (ICSI) was done on all of retrieved oocytes.

          Results: In IVF group, fertilization and implantation rates were significantly higher than ICSI group (66.22% and 16.67% in IVF group versus 57.46% and 11.17% in ICSI group, respectively). Chemical and clinical pregnancy rates were statistically higher in IVF group as compared with the ICSI group (42.9% vs. 27.3% and 35.7% vs. 21.5%, respectively).

          Conclusion: According to our study, the routine use of ICSI is not improved fertilization, implantation and chemical pregnancy rates and is not recommended in non-male factor, normozoospermic patients.

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          Most cited references22

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          Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial.

          Intracytoplasmic sperm injection (ICSI) is a more invasive option than conventional in-vitro fertilisation (IVF), which can be successful even when semen characteristics are poor. Reports of higher fertilisation rates after ICSI suggest that this technique may be better than the conventional method for all couples seeking IVF. We undertook a multicentre randomised controlled trial comparing clinical outcome after ICSI or traditional IVF in couples with non-male-factor infertility. 415 eligible and consenting couples at four UK centres were randomly assigned IVF or ICSI (total 435 treatment cycles: IVF 224; ICSI 211). Usual clinical and laboratory protocols for the two treatment procedures were followed in each of four participating centres. The primary outcome was the implantation rate (number of gestation sacs per embryo replaced expressed as a percentage). Secondary outcomes were pregnancy and fertilisation rates associated with each treatment. Analyses were by intention to treat. The implantation rate was higher in the IVF group than in the ICSI group (95/318 [30%] vs 72/325 [22%]; relative risk 1.35 [95% CI 1.04-1.76]). The pregnancy rate per cycle was also higher after IVF (72 [33%] vs 53 [26%]; 1.17 [0.97-1.35]). Mean associated laboratory time was significantly shorter with IVF than with ICSI (22.9 [SD 12.1] vs 74.0 [38.1] min; 95% CI for difference 45.6-56.6). ICSI offers no advantage over IVF in terms of clinical outcome in cases of non-male-factor infertility. Our results support the current practice of reserving ICSI only for severe male-factor problems.
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            A review of ten years experience of ICSI.

            This review summarizes the introduction of ICSI in the early 1990s as an assisted fertilization procedure in couples with severe male factor infertility, who could not be helped by conventional IVF. As for current practice, the indications for ICSI using fresh or frozen-thawed ejaculated, epididymal or testicular sperm are reviewed as well as some reports on the use of ICSI in non-male infertility. The main steps in an ICSI cycle are well standardized by now; it is rare that ICSI cannot be carried out and the results in terms of fertilization, embryo transfer and clinical pregnancy rate have been consistent for many years, indicating that a substantial number of couples can now have their own genetic child instead of having to use artificial insemination with donor sperm. This review also emphasizes the importance of assessing the risk of ICSI for the children: there is a slight increase in de novo chromosomal abnormalities, the major congenital malformation rate is similar for IVF and ICSI (between 3 and 4%), and at approximately 2 years of age the developmental outcome as assessed by the Bayley scale is similar for IVF and ICSI. Recent publications mention that a few children are affected by diseases caused by imprinting disorders. Future studies are needed to assess the association between assisted reproductive technologies and imprinting disorders. ICSI is frequently used in couples undergoing preimplantation genetic diagnosis. PGD stricto sensu as well as PGD for aneuploidy screening and for Klinefelter patients are reviewed using the ESHRE PGD Consortium data.
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              Blastocyst formation in in vitro fertilization versus intracytoplasmic sperm injection cycles: influence of the fertilization procedure.

              To compare the quality of early cleaving embryos and blastocysts obtained by IVF or intracytoplasmic sperm injection (ICSI). Retrospective study. Tertiary infertility center. Sibling oocytes of 104 patients in 104 IVF vs. ICSI cycles. Cumulus oocyte complexes (n = 1,358) were randomly subjected to ICSI or IVF. Embryo development and blastocyst formation rate. The blastocyst quality and cycle efficiency were also evaluated. Early embryo cleavage was higher after ICSI (37.1%) compared to IVF (14.1%). The percentage of > or =4-cell embryos on day 2 and > or =8-cell embryos on day 3 was similar for both procedures. The overall blastocyst formation was not different between ICSI (50.2%) and IVF (54.8%), neither was the percentage of good-quality blastocysts (31.3% for ICSI and 36.0% for IVF). The total cycle efficiency (percentage of embryos transferred and frozen per two pronuclei [2PN]) was comparable for the two techniques (51.7% for ICSI and 57.4% for IVF). No differences were found on sibling oocytes in the embryo development and blastocyst formation, irrespective of the fertilization procedure. Earlier suggestions that the ICSI technique may result in impaired blastocyst development were not confirmed in this study.
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                Author and article information

                Journal
                Iran J Reprod Med
                Iran J Reprod Med
                IJRM
                Iranian Journal of Reproductive Medicine
                Research and Clinical Center for Infertility (Yazd, Iran )
                1680-6433
                2008-2177
                March 2012
                : 10
                : 2
                : 131-136
                Affiliations
                [1 ] Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
                [2 ] Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Azadi Avenue, Zanjan, Iran.
                Author notes
                Corresponding Author: Farnaz Mohammadian, Zanjan University of Medical Sciences, Azadi Avenue, Zanjan, Iran. Email: mohamadian@zums.ac.ir; Mohammadian_farnaz@yahoo.com ,Tel/Fax: (+98) 9122413354
                Article
                ijrm-10-131
                4163275
                25242986
                d193ec99-6e7a-4a22-8d7c-c7c24fe84de1

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 April 2011
                : 5 May 2011
                : 24 May 2011
                Categories
                Original Article

                infertility,icsi,in-vitro fertilization,fertilization,pregnancy rate

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