Should We Be Offering Intracytoplasmic Sperm Injection to All Couples with Unexplained Infertility: A Cohort Study.

Area of Science:

• Reproductive Medicine
• Infertility Treatment
• Assisted Reproductive Technologies

Background:

• Unexplained infertility (UI) often leads to increased use of intracytoplasmic sperm injection (ICSI) to prevent total fertilization failure (TFF).
• Limited evidence currently supports improved clinical outcomes with ICSI in UI cases.

Purpose of the Study:

• To evaluate if ICSI offers better outcomes than conventional in vitro fertilization (IVF) for patients with unexplained infertility.
• To compare key fertility metrics between ICSI and IVF cycles in UI.

Main Methods:

• A retrospective cohort study was conducted at a tertiary center.
• Patients with UI (females aged 21-38) undergoing their first stimulation cycle were divided into ICSI (Group A) and IVF (Group B) groups.
• Exclusion criteria included rescue-ICSI, donor cycles, and pre-implantation genetic diagnosis; outcomes assessed were fertilization rate, TFF, embryo quality, implantation, miscarriage, and clinical pregnancy rates.

Main Results:

• A total of 511 UI patients (182 ICSI, 310 IVF) were analyzed with similar baseline characteristics.
• Fertilization rates were comparable (67.18% ICSI vs. 66.93% IVF, P=0.92).
• Total fertilization failure (TFF) was lower in the ICSI group (2.7% vs. 5.8%, P=0.12), though not statistically significant. Good-quality day 3 embryo rates were similar (P=0.93). Implantation and clinical pregnancy rates were numerically higher in the IVF group but not statistically significant (P>0.05).

Conclusions:

• ICSI demonstrated a trend towards reduced TFF in unexplained infertility compared to IVF.
• Clinical outcomes, including fertilization rates, embryo quality, implantation, and pregnancy rates, were comparable between ICSI and IVF groups in this UI cohort.
• The study suggests ICSI may not offer significant clinical advantages over conventional IVF for unexplained infertility, despite a potential reduction in TFF.