Trends in the Use and Indications for Intracytoplasmic Sperm Injection Between 2005 and 2017: A State-Wide...

Intracytoplasmic sperm injection (ICSI) was first developed to overcome male factor infertility. ICSI has increased in uptake globally, including in cases where its use is non-essential for fertilisation.

To identify temporal trends in the use of, and indications for ICSI in an Australian context.

A statewide descriptive cohort study examining the trends in ICSI uptake and reported indication/s for ICSI use. The cohort included women undergoing IVF between 2005 and 2017 at IVF clinics across Victoria, Australia that resulted in a birth after 20 weeks' gestation.

The dataset comprised 32 102 assisted reproduction cycles: 22 873 (71.3%) ICSI and 9229 (28.7%) conventional IVF. In 2005, ICSI accounted for 60.6% (1182/1952) of cycles, increasing to 79.5% (2344/2947) by 2017 (p_trend < 0.001). Testicular sperm retrieval as an indication for ICSI remained consistent over time (p_trend = 0.15). Male factor infertility as an indication decreased over time (p_trend = 0.007). Vitrified oocyte thaw (p_trend = 0.016) and 'unexplained subfertility' (p_trend = 0.30) cycles did not surpass 1.7% (39/2293) and 0.4% (9/2048), respectively of total cycles in any year. Donor sperm (p_trend = 0.001), pre-implantation genetic testing (p_trend = 0.004), female factors associated with poor IVF outcome (p_trend = 0.005) and advanced maternal age (p_trend = 0.005) all increased as indications for ICSI over time. 'Unspecified' indication accounted for the majority of ICSI cycles after 2008 (p_trend = 0.015).

During our study period, the total use of ICSI increased by 18.9%. Notably, most of these cycles were not medically indicated.