Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection

Abstract

IMPORTANCE: Intracytoplasmic sperm injection (ICSI) is increasingly used in patients without severe male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF). OBJECTIVE: To assess national trends and reproductive outcomes for fresh IVF cycles (embryos transferred without being frozen) following the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use. DESIGN, SETTING, AND POPULATION: Retrospective cohort study using data on fresh IVF and ICSI cycles reported to the US National Assisted Reproductive Technology Surveillance System during 1996-2012. MAIN OUTCOMES AND MEASURES: Trends in ICSI use during 1996-2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield, and 2 or more prior assisted reproductive technology cycles; reproductive outcomes for conventional IVF and ICSI cycles during 2008-2012, stratified by the presence or absence of male factor infertility. RESULTS: Of the 1 395 634 fresh IVF cycles from 1996 through 2012, 908 767 (65.1%) used ICSI and 499 135 (35.8%) reported male factor infertility. Among cycles with male factor infertility, ICSI use increased from 76.3%(10 876/14 259) to 93.3%(32 191/34 506) (P