Fertilization by ICSI generates a higher number of live births than IVF in a pioneer facility applying >90% single blastocyst-stage embryo transfers
DOI:
https://doi.org/10.30574/gscbps.2021.15.1.0104Keywords:
Assisted reproductive technology (ART), In vitro fertilization (IVF), Intracytoplasmic sperm injection (ICSI), IVF-ICSI Split, Miscarriage, Pregnancy productivity rate, Live birth productivity rateAbstract
Following earlier studies introducing an IVF-ICSI Split model on couples with unexplained infertility to avoid the scenario of unexplained failed or poor fertilization, PIVET has adopted a high ICSI rate approaching 90%, whereas the general rate among Australian facilities is around 60%. This observational study with retrospective data analysis reports on the IVF±ICSI procedures conducted over the period 2011 to 2019 with follow-up of ensuing pregnancies through 2020. Using autologous oocytes, 2343 women had 3434 IVF±ICSI cycles where 84.5% of women had 88.9% of initiated treatment cycles using ICSI and only 5.3% of women had 4.0% of cycles by IVF. The remaining 10.1% of women utilized the IVF-ICSI Split model for the remaining 7.2% of cycles. It was shown that oocyte fertilization rates were significantly higher for ICSI (p<0.0001), but not significant for women >40 years. The utilization rates of the ensuing embryos were ~45% across all ages with no significant differences across the ages, except for those small numbers of women ≥45 years who had a higher rate from IVF-generated embryos (p<0.0002). Pregnancy outcome were higher from ICSI-generated embryos across the age groups, being especially marked among the younger women <40 years (p<0.0001). Miscarriage rates were lowest for the IVF-generated pregnancies (overall 6.7% vs 22.8%, p<0.0001) but nevertheless the final live birth productivity rates per initiated treatment cycle remained higher from the ICSI-generated pregnancies (56.5% vs 46.3%; p<0.0001). Although this study does not meet the highest standards for EBM, it emanates from a pioneer facility with >40 years of published activity and which practices 90% blastocyst transfers in >90% SET cycles. The study supports a high ICSI rate of almost 90% and an IVF-ICSI Split rate of 10%.
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References
Yovich JL, Craft IL. Founding pioneers of IVF: Independent innovative researchers generating livebirths within 4 years of the first birth. Reprod Biol. 2018; 18: 317-323.
Yovich JL. Founding pioneers of IVF Update: Independent innovative researchers generating livebirths within 4 years of the first birth. Reprod Biol. 2020; 20: 111-113.
Yovich JL, Stanger JD, Yovich JM, Turner SR, Newman BD. Treatment of male infertility by in-vitro fertilization. Lancet. 1984; i: 169-170.
Yovich JL, Matson PL. Male subfertility: concepts. Hum Reprod. 1995; 10: 3-9.
Yovich JL, Stanger JD, Kay D, Boettcher B. In-vitro fertilization of oocytes from women with serum antisperm antibodies. Lancet. 1984; ii: 369-370.
Matson PL, Junk SM, Spittle JW, Yovich JL. Effect of antispermatozoal antibodies in seminal plasma upon spermatozoal function. International Journal of Andrology. 1998; 11(2): 101-106.
Yovich JL. Indications and techniques of in vitro fertilization. In: 40 Years After In Vitro Fertilization: State of the ART and New Challenges (Ed: Jan Tesarik). Cambridge Scholars Publishing, Lady Stephenson Library, Newcastle Upon Tyne, UK. 2019; 25-74.
Yovich JL, Stanger JD. The limitations of in-vitro fertilization from males with severe oligospermia and abnormal sperm morphology. J In Vitro Fert Embryo Transfer. 1984; 1(3): 172-179.
Yovich JL, Stanger JD, Yovich JM. Management of oligospermic Infertility by in-vitro fertilization. Ann Ny Acad Sci. 1985; 442: 276-286.
Yovich JL, Stanger JD, Yovich JM, Turner SR, Newman BD. Treatment of male infertility by in-vitro fertilization. Lancet. 1984; i: 169-170.
Yovich JL, Matson PL. The influence of infertility aetiology on the outcome of in-vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) treatments. Int J Fertil. 1989; 35: 26-33.
Yovich JL. individualization of sperm preparations. J Assist Reprod Genet. 1993; 10: 247-250.
Yovich JM, Edirisinghe WR, Cummins JM, Yovich JL. Preliminary results using pentoxifylline in a PROST program for severe male factor infertility. Fertil Steril. 1988; 50: 179-181.
Yovich JL. Pentoxifylline: actions and applications in assisted reproduction. Hum Reprod. 1993; 8: 1786-91.
Edirisinghe WR, Junk S, Yovich JM, Bootsma B, Yovich JL. Sperm stimulants can improve fertilization rates in male factor cases undergoing IVF to the same extent as micromanipulation by partial zona dissection (PZD) or sub-zonal sperm insemination (SUZI): A Randomized Controlled Study. J Assist Reprod Genet. 1995; 12(5): 312-318.
Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992; 340(8810): 17-18.
Yovich JL, Edirisinghe WR, Apted SI, Yovich JM. Pregnancy from microinjected epididymal spermatozoa. Med J Aust. 1993; 159: 71-72.
O’Neill CL, Chow S, Rosenwaks Z, Palermo GD. Development of ICSI. Reproduction. 2018; 156: F51-F58.
Yovich JM, Edirisinghe WR, Yovich JL. Use of the acrosome reaction to ionophore challenge test (ARIC) in managing patients in an assisted reproduction programme. Fertil Steril. 1994; 61: 902-910.
Virro MR, Larson-Cook KL, Evenson DP. Sperm chromatin structure assay (SCSA) parameters are related to fertilization, blastocyst development, and ongoing pregnancy in in vitro fertilization and intracytoplasmic sperm injection cycles. Fertil Steril. 2004; 81(5): 1289-1295.
Stanger JD, Vo L, Yovich JL, Almahbobi G. Hypo-osmotic swelling test identifies individual spermatozoa with minimal DNA fragmentation. Reprod Biomed Online. 2010; 20: 474-484.
Yovich JL, Keane KN. Assessing the male in infertility clinics - men undervalued, undermanaged and undertreated. 2017 Transl Androl Urol. 2017; 6: S624-628.
Yovich JL, Mustafa KB, Marjanovich N, Yovich SJ, Keane KN. IVF-ICSI Split insemination reveals those cases of unexplained infertility benefitting from ICSI even when the DNA fragmentation index is reduced to 15% or even 5%. Androl Gynecol: Curr Res. 2016; 4: 1.
Newman JE, Paul RC, Chambers GM. Assisted reproductive technology in Australia and New Zealand 2018. Sydney: National Perinatal Epidemiology and Statistics Unit, the University of New South Wales, Sydney. 2020; 1-83.
Li Z, Wan AY, Bowman M, Hammarberg K, Farquar C, Johnson L, Safi N, Sullivan EA. ICSI does not increase the cumulative live birth rate in non-male factor infertility. Hum Reprod. 2018; 33(7): 1322-1330.
Yovich JL, Conceicao JL, Marjanovich N, Ye Y, Hinchliffe PM, Dhaliwal SS, Keane KN. An ICSI rate of 90% minimizes complete failed fertilization and provides satisfactory implantation rates without elevating fetal abnormalities. Reprod Biol. 2018; 18: 301-311.
Yovich JL. How to Prepare the Egg and Embryo to Maximise IVF Success. In: Monitoring the stimulated IVF cycle. Section II: Stimulation for IVF (Eds: Gabor T Kovacs, Anthony J Rutherford, David K Gardner). Cambridge University Press, Cambridge. 2019; 94-120.
Yovich J, Stanger J, Hinchliffe P. Targeted gonadotrophin stimulation using the PIVET algorithm markedly reduces the risk of OHSS. Reprod Biomed Online. 2012; 24(3): 281-292.
Yovich JL, Alsbjerg B, Conceicao JL, Hinchliffe PM, Keane KN. PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome. Drug Des Devel Ther. 2016; 10: 2561–2573.
Yovich JL, Keane KN, Borude G, Dhaliwal SS, Hinchliffe PM. Finding a place for corifollitropin within the PIVET FSH-dosing algorithms. Reprod Biomed Online. 2017.
Yovich JL, Hinchliffe PM, Lingam S, Srinivasan S, Keane KN. Adjusting the PIVET rFSH dosing algorithm for the biosimilar Bemfola product. J Fertil In vitro IVF Worldw Reprod Med Genet Stem Cell Biol. 2018; 5: 3.
Kuwayama M, Vajta G, Kato O, Leibo SP. Highly efficient vitrification method for cryopreservation of human oocytes. Reprod Biomed Online. 2005; 11: 300-308.
Yovich JL, Stanger JD, Keane KN. Cumulative Live Birth Rate: An Outmoded Term. JFIV Reprod Med Genet. 2016; 4: 165.
WHO: WHO laboratory manual for the examination and processing of human semen, 5th ed. Geneva: World Health Organization. 2010; 270.
Yovich JL, Katz D, Jequier AM. Sperm recovery for men with spinal cord injury: vasal flush is the preferred method for an-ejaculatory males. J Fertil In Vitro IVF Worldw Reprod Med Genet Stem Cell Biol. 2018; 6(1): 1-6.
Jequier AM. Physical agents, toxins and drugs: their effect upon male fertility. In: Male Infertility. A Clinical Guide. Cambridge University Press. Second Edition. 2011; 197-208.
Ludwig M, al-Hasani S, Küpker W, Bauer O, Diedrich K. A new indication for an intracytoplasmic sperm injection procedure outside the cases of severe male factor infertility. Eur J Obstet Gynecol Reprod Biol. 1997; 75(2): 207-210.
Ou YC, Lan KC, Huang FJ, Kung FT, Lan TH, Chang SY. Comparison of in vitro fertilization versus intracytoplasmic sperm injection in extremely low oocyte retrieval cycles. Fertil Steril. 2010; 93: 96–100.
Gozlan I, Dor A, Farber B, Meirow D, Feinstein S, Levron J. Comparing intracytoplasmic sperm injection and in vitro fertilization in patients with single oocyte retrieval. Fertil Steril. 2007; 87: 515–518.
Zhao J, Zhang N-Y, Xu Z-P, Chen L-J, Zhao X, Zeng H-M, Jiang Y-Q, Sun H-X. Effects of abnormal zona pellucida on fertilization and pregnancy in IVF/ICSI-ET. J Reprod Contraception 2015; 26; 73-80.
Van der Westerlaken L, Helmerhorst F, Dieben S, Naaktgeboren N. Intracytoplasmic sperm injection as a treatment for unexplained total fertilization failure or low fertilization after conventional in vitro fertilization. Fertil Steril. 2005; 83: 612–617.
Vitek WS, Galarraga O, Klatsky PC, Robins JC, Carson SA, Blazar AS. Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril. 2013; 100(5): 1381–1388.
Ruiz A, Remohi J, Minguez Y, Guanes PP, Simon C, Pellicer A. The role of in vitro fertilization and intracytoplasmic sperm injection in couples with unexplained infertility after failed intrauterine insemination. Fertil Steril. 1997; 68(1): 171–173.
Harton GL, De Rycke M, Fiorentino F, Moutou C, SenGupta S, Traeger- Synodinos J, Harper JC. European Society for Human Reproduction and Embryology (ESHRE) PGD Consortium. ESHRE PGD consortium best practice guidelines for amplification-based PGD. Hum Reprod. 2011; 26(1): 33-40.
Yovich JL, Mariappen U, Hinchliffe PM, Dhaliwal SS, Keane KN. MPA given orally during the first trimester for threatened miscarriage carries no specific risk for foetal abnormalities albeit the rate is higher than non-threatened pregnancies. Reprod Biol 2020 in press.
Tannus S, Son W-Y, Gilman A, Younes G, Shavit T, Dahan M-H. The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age. Hum Reprod. 2017; 32(1): 119-124.
American Society for Reproductive Medicine. Practice Committee for the Society of Assisted Reproductive technology. Intracytoplasmic sperm injection (ICSI) for non-male factor indications: a committee opinion. Fertil Steril. 2020; 114: 239-245.
Geng T, Cheng L, Ge C, Zhang Y. The effect of ICSI in infertility couples with non-male factor: a systematic review and meta-analysis. J Assist Reprod Genet. 2020; 37(12): 2929-2945.
Zheng D, Zeng L, Yang R, Lian Y, Zhu Y-M, Liang X, Tang L, Wang H, Cao Y, Hao G, Liu J, Zhao J, Wang R, Mol BW, Li R, Huang H-F, Qiao J. Intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilization (IVF) in couples with non-severe male infertility (NSMI-ICSI): protocol for a multicentre randomized controlled trial. BMJ Open. 2019; 9: e030366 1-9.
Nelson SM, Lawlor DA. Predicting live birth, preterm delivery, and low birth weight in infants born from in vitro fertilisation: a prospective study of 144,018 treatment cycles. PLoS Med. 2011; 8(1): e1000386.
Van Rumste MM, Evers JL, Farquar CM, Blake DA. Intra-cytoplasmic sperm injection versus partial zona dissection, subzonal insemination and conventional techniques for oocyte insemination during in vitro fertilization. Cochrane Database Syst Rev. 2000; (2): CD001301.
Van Rumste MM, Evers JL, Farquar CM. Intra-cytoplasmic sperm injection versus conventional techniques for oocyte insemination during in vitro fertilization in patients with non-male subfertility. Cochrane Database Syst Rev. 2003; (2): CD001301.
Sauerbrun-Cutler M-T, Huber WJ 3rd, Has P, Shen C, Hackett, Alvero R, Wang S. Is intracytoplasmic sperm (ICSI) better than traditional in vitro fertilization (IVF): confirmation of higher blastocyst rates per oocyte using a split insemination design? J Assist Reprod Genet. 2020; 37(7): 1661-1667.
Simerly CR, Takahashi D, Jacoby E, Castro C, Hartnett C, Hewitson L, Navara C, Shatten G. Fertilization and cleavage axis differ in primates conceived by conventional (IVF) versus intracytoplasmic sperm injection (ICSI). Sci Rep. 2019; 9: 152-82
Sanchez AD, Feldman JL. Microtubule-organising centers: from the centrosome to non-centrosomal sites. Current Opinion in Cell Biology. 2017; 44: 93-101.
Lamarta C, Ortega C, Villa S, Pommer R, Schwarze JE. Are children born from singleton pregnancies conceived by ICSI at increased risk for congenital malformations when compared to children conceived naturally? A systematic review and meta-analysis. JBRA Assisted Reprod. 2017; 21(3): 251-259.
Yovich JL. The effect of ICSI-related procedural timings and operators on the outcome. GSC Biological and Pharmaceutical Sciences. 2020; 11(01): 09-11.
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