ICSI Or Not ICSI Steven Fleming PhD

Male factor infertility is estimated to account for one third of all couples that fail to conceive and ICSI can circumvent this problem. However, data from the Australian and New Zealand Assisted Reproduction Database shows that ICSI is used to treat over 60% of all couples. Indeed, this phenomenon is by no means restricted to Australasia with some IVF centres even advocating an ICSI for all policy. Clearly, there is a major discrepancy between the observed rate of male factor infertility and the reported utilization of ICSI to treat infertile couples. The explanation for this is not readily apparent but the excessive use of ICSI could be due to multiple factors including erroneous semen analysis results, lack of evidence-based interpretation of semen analysis reports, compromised methodology that results in low fertilization rates following standard IVF, and the generation of greater income through the provision of ICSI in preference to IVF in those IVF centres that have a differential fee structure for the two different insemination methods. It could be argued that all patient groups should be treated with ICSI. However, this argument is neither valid nor proven, and it should be remembered that ICSI is costly, labour-intensive and is a more invasive technique than standard IVF. Therefore, especially while there remain concerns over the long-term safety of ICSI, it should only be viewed as an insemination option for specific aetiologies of infertility. Since ICSI is a more costly process than IVF for the patient, the IVF centre and the Department of Health, it is difficult to justify its utilization in patients that clearly do not require it to resolve their sub-fertility.