Common IVF add-on may be ‘a waste of time’, says study

One of the most common IVF add-ons undertaken globally could be a “waste of time”, a new study has found.

The research, conducted by Monash University’s Professor Ben Mol in Australia and Dr Rui Wang and colleagues in China, found that intracytoplasmic sperm injection (ICSI), whereby a single sperm is injected directly into a mature egg, could be an expensive waste of time, in some cases even reducing the chances of success.

Originally developed in 1992 for couples with severe male infertility, ICSI has since expanded in use in more than half of all embryo transfers in Australia and elsewhere.

Over the past 30 years, use of ICSI has increased and now accounts for nearly two thirds of IVF cycles worldwide, including 70 per cent in Europe and North America and nearly 100 per cent in some low-income and middle-income countries.

In 2021, over 100,000 IVF cycles were performed in Australia and New Zealand resulting in the birth of 20,690 babies, a record high for IVF medical treatments.

The proportion of embryo transfer cycles that used embryos fertilised using ICSI was 55.6 per cent in 2021. However, according to Professor Ben Mol, severe male infertility only impacts 30 per cent of couples.

“The use of ICSI far outweighs its original purpose and has been adopted as a general IVF procedures in Australia and globally,” he said.

Mol’s study, published in The Lancet, looked at ten reproductive medicine centres across China. Couples with infertility with non-severe male factor without a history of poor fertilisation were randomly assigned to undergo either ICSI or conventional IVF. The primary outcome was live birth after first embryo transfer.

For a three-and-a-half year period from 2018 to 2021, 2,387 couples were randomly assigned to the ICSI group and the remainder to the conventional IVF group.

Live birth after first embryo transfer occurred in 34 per cent couples in the ICSI group and in 37 per cent of couples in the conventional IVF group.

Looking at the total number of babies born from the started cycle taking into account multiple transfers, this difference increased to 45 per cent after ICSI versus 51 per cent after IVF.

The study, Mol said, showed that in couples with infertility with non-severe male factor, ICSI did not improve live birth rate compared with conventional IVF.

“Given that ICSI is an invasive procedure associated with additional costs and potential increased risks to offspring health, routine use is not recommended in this population,” he said.

He added: “The increased use of ICSI in couples with infertility without severe male factor has boomed because of the belief that use of ICSI might increase fertilisation success, and now we have shown that this is incorrect.”

There are also concerns about ICSI – an invasive procedure that bypasses natural selection barriers during the fertilisation process. A recent Australian study indicated a small increased risk for genitourinary abnormalities after ART, particularly after ICSI.

Professor Mol said: “Because a single sperm is isolated and injected into the egg, the natural selection process where a sperm cell beats millions of competitors is bypassed, which may lead concerns re potential risks to offspring health, including congenital anomalies.”