ICSI for non-male factor: do we practice what we preach?

Area of Science:

• Reproductive medicine
• Infertility treatment
• Assisted reproductive technology

Background:

• Intracytoplasmic sperm injection (ICSI) was introduced in 1992.
• ICSI initially revolutionized male factor infertility treatment.
• Recent trends show increased ICSI use for non-male factors, contradicting established guidelines.

Purpose of the Study:

• To analyze the increasing utilization of ICSI for non-male factor infertility.
• To investigate the underlying reasons for the excessive use of ICSI.
• To contrast the current application of ICSI with evidence-based recommendations.

Main Methods:

• Review of historical data on ICSI application.
• Analysis of trends in ICSI utilization over three decades.
• Comparison of ICSI usage patterns with professional society guidelines.

Main Results:

• ICSI significantly advanced the treatment of severe male factor infertility.
• A dramatic increase in ICSI use for non-male factors has been observed.
• This trend persists despite professional guidelines advising against it.

Conclusions:

• The widespread use of ICSI for non-male factors is driven by an irrational fear of fertilization failure.
• This excessive utilization is not supported by rational evidence.
• Revisiting evidence-based practices is crucial for appropriate ICSI application.