Intra-cytoplasmic sperm injection versus conventional techniques for oocyte insemination during in vitro fertilisation in patients with non-male subfertility.

backgroundIn vitro fertilisation (IVF) as treatment for male factor subfertility is associated with lower fertilisation and pregnancy rates than for other indications. Since the late 1980s several assisted fertilisation techniques have emerged and have been rapidly developed to try to enhance results for couples with male factor subfertility, or to help couples with severe male factor for whom conventional IVF was not possible. The techniques of partial zona dissection (PZD) and of subzonal microinjection of spermatozoa into the perivitelline space (SUZI) are by far surpassed by the technique of intra-cytoplasmatic sperm injection (ICSI). ICSI has proven to be the therapy of choice for couples with severe male factor subfertility.

objectivesTo investigate whether ICSI improves livebirth rate in comparison to IVF in couples with non-male subfertility. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched 30 May 2002), the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2002), PubMed (January 1992 to July 2002) and reference lists of articles. SELECTION CRITERIA: Trials were included if they compared the effects of these techniques on livebirths, pregnancy and fertilisation outcomes. Only randomised studies were included in this review. DATA COLLECTION AND ANALYSIS: One study met the inclusion criteria for this review. The study compared ICSI with IVF within couples with non-male infertility. Data was extracted independently by two reviewers. MAIN

resultsThere were no randomised data comparing livebirth rates. The single identified study did not find a difference in pregnancy rates (OR 1.4, 95% CI 0.95 to 2.2). There were no randomised data on miscarriage rates, or on other adverse events such as congenital malformations that may be of concern. REVIEWER'S

conclusionsWhether ICSI should be preferred to IVF for cases of non-male factor subfertility remains an open question. Further research should report livebirth rates and adverse events.