IVF add-on procedure that costs an extra £1,000 is actually LESS effective for couples in which the man has healthy sperm
- Researchers in Melbourne, Australia, looked at more than 3,000 fertility cycles
- They found just 13.2 per cent of ICSI procedures resulted in a live birth
- Despite its lower success rate, ICSI is becoming more standard for all couples
An IVF add-on treatment costing an extra £1,000 may be ‘significantly’ less effective than routine IVF for healthy men, a study has found.
Intracytoplasmic sperm injection (ICSI) is a procedure used when the man has reduced fertility, and works by injecting a single sperm into an egg in a lab.
Researchers discovered the procedure is becoming more common among couples in which the man has normal sperm, but it’s actually less effective for them than IVF.
There were more only 62 per cent as many pregnancies if couples with healthy sperm used ICSI and only 13.2 per cent of cycles resulted in a live baby being born.
An IVF add-on called intracytoplasmic sperm injection, in which solo sperm are individually injected into eggs, has been found to have a lower pregnancy and live birth rate than standard IVF in couples where the man has normal sperm (stock image)
Experts at the Royal Women’s Hospital in Melbourne and Melbourne IVF, a private fertility company, did the research.
They studied fertilisation rates among couples using normal IVF – in which semen and eggs are mixed in a lab – and ICSI for a total of 3,363 cycles.
Clinics and couples are increasingly turning to ICSI in Australia and New Zealand, they said, which seemed to be at odds with what scientific evidence supports.
The researchers suggested the procedure may be less successful because weak, unsuitable sperm could be selected for injection.
‘The growing use of ICSI in the presence of normal semen analysis has raised concern,’ the researchers, led by Dr Genia Rozen at the women’s hospital, said.
‘Studies aimed at verifying the [effectiveness] of ICSI over IVF in this setting are inconsistent.’
In their study the researchers found the use of ICSI for men with normal sperm counts in all fertility treatments rose from 59.1 per cent in 2008 to 63 per cent in 2015 in Australia and New Zealand.
Similar trends were seen in the US and some countries, including Italy, the researchers said, have used it in up to 98 per cent of IVF treatments.
HOW COULD ICSI REDUCE A COUPLE’S CHANCE OF CONCEIVING?
ICSI is a treament in which a single sperm is injected into the egg.
It was developed for use when the man has been diagnosed with infertility and there is a severe problem with his sperm.
It is a slightly more specialised form of IVF.
In standard IVF, eggs are taken from a woman’s ovaries and mixed in a dish with her partner’s semen sample usually containing about 150,000 sperm.
One or two of these fertilised eggs, or embryos, are then implanted back into the uterus.
In ICSI a single sperm is injected directly into each egg using a fine glass needle.
The process helps couples hit by male infertility problems – for example, if the male partner has a low sperm count or damaged sperm.
But only 30 to 40 per cent of couples’ problems are caused by severe male infertility, so scientists say no more than 40 per cent should have ICSI.
When given to couples where male infertility is not the problem, it simply reduces the number of healthy sperm available to fertilise the egg.
They wrote: ‘In addition to efficacy there are safety concerns.
‘Despite its widespread application, ICSI has not been subjected to ethical review, animal studies or rigorous testing in humans to assess biological impact and overall safety.
‘The procedure bypasses natural selection safeguards, which may affect offspring and future generations.
‘Chromosomal damage may occur due to the injection of non-capacitated [sperm] which with natural fertilisation would never enter the [eggs].
‘Furthermore, it is possible that incubation and pre-treatment of spermatozoa during ICSI results in DNA damage.’
The study’s results found the pregnancy rate in healthy sperm couples using ICSI was 16.08 per cent, lower than the 23.06 per cent in those using routine IVF.
The live birth rate was lower, too, with just 13.2 per cent compared to 17.22 per cent.
If ICSI was used without clear medical reasons why, fertility treatments led to one less pregnancy for every 15 cycles completed.
The UK’s Human Fertilisation and Embryology Authority explains ICSI is a treatment used to overcome male fertility.
It said the average cost of the procedure was between £500 and £1,000 on top of a normal IVF cycle, which may cost more than £5,000.
The HFEA says: ‘For most people who have no evidence of male factor infertility, the chances of getting pregnant are the same whether they have ICSI or not and it will cost more if you’re paying for your own treatment.’
It adds there are concerns the procedure may raise the risk of birth defects in children.
The Australian team’s research was published in the Australian and NZ Journal of Obstetrics and Gynaecology.