Fertility Technique Common, Despite Doubts
ICSI rates surging in U.S., but studies question its effectiveness, safety
WEDNESDAY, July 18, 2007 (HealthDay News) -- The use of a fertility technique called intracytoplasmic sperm injection, which involves injecting a sperm directly into an egg, has increased dramatically in the United States since 1995, despite uncertainty about its effectiveness and risks, researchers say.
A study published in the July 19 issue of the New England Journal of Medicine analyzed data on fertility treatments from 1995 to 2004. The study included all in vitro fertilization (IVF) cycles involving fresh embryos from non-donor eggs in women younger than 43.
The team found that while the proportion of patients receiving treatment for male factor infertility has remained stable, the percentage of IVF cycles that used intracytoplasmic sperm injection (ICSI) increased from 11 percent to 57.5 percent during the 10-year time span.
"Despite its added cost and uncertain efficacy and risk, the use of ICSI has been extended to include patients without documented male-factor infertility," the study's lead author Dr. Tarun Jain, assistant professor of reproductive endocrinology and infertility at the University of Illinois at Chicago, said in a prepared statement.
When compared to states without mandated insurance coverage, states with mandated coverage for infertility (Illinois, Massachusetts and Rhode Island), had higher rates of ICSI for reasons other than male-factor infertility.
Jain said some physicians may feel ICSI is appropriate for patients who had prior IVF cycles that failed, for those who have very few eggs available, or to overcome barriers to the normal fertilization process.
But, according to Jain, the largest study to compare traditional IVF with ICSI in patients without male-factor infertility found that patients who underwent ICSI had lower rates of embryo implantation and pregnancy than patients who did not have ICSI.
There is also limited research evaluating the routine use of ICSI and the possibility of associated risks, such as genetic disorders and congenital abnormalities in babies conceived with this technology.
"Further studies are needed to better understand the proper role of ICSI, and perhaps guidelines may be useful to determine what the best indications are for the use of the technology in patients without male-factor infertility," Jain said.
In addition to their findings on ICSI, the researchers found that the number of fertility clinics and number of fresh-embryo cycles has increased, as have pregnancy and live-birth rates.
There's more on ICSI at Cornell University.