ICSI for non-male factor: do we practice what we preach?

Area of Science:

• Reproductive Medicine
• Infertility Treatment
• Assisted Reproductive Technology

Background:

• Intracytoplasmic sperm injection (ICSI) was introduced in 1992 for severe male factor infertility.
• ICSI has significantly advanced the treatment of male infertility.
• Recent trends show increased ICSI use for non-male factors, diverging from established guidelines.

Purpose of the Study:

• To analyze the increasing utilization of ICSI beyond its primary indication.
• To investigate the driving factors behind the excessive use of ICSI.
• To contrast the perceived risks with evidence-based recommendations for ICSI.

Main Methods:

• Review of historical data on ICSI application trends.
• Analysis of professional society guidelines regarding ICSI use.
• Evaluation of evidence supporting or refuting ICSI for non-male factor infertility.

Main Results:

• ICSI use for non-male factor infertility has risen substantially over 30 years.
• This increased utilization is linked to a fear of total fertilization failure.
• Current evidence does not fully support widespread ICSI use for non-male factors.

Conclusions:

• The overuse of ICSI for non-male factors is driven by irrational fears, not clinical evidence.
• Adherence to guidelines and evidence-based practice is crucial for appropriate ICSI utilization.
• Reassessing the indications for ICSI is necessary to ensure cost-effective and rational infertility treatment.