September 15th, 2019

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Is Routine Intracytoplasmic Sperm Injection Justified in Couples with Unexplained Infertility? A Randomized Controlled Trial Using Sibling Oocytes
Authors:  Cathy Hoi Sze Chung, M.B.Ch.B., Alice Wai Yee Wong, M.B.Ch.B., Queenie Sum Yee Yeung, M.S., Lai Ping Cheung, M.B.Ch.B., and Tin Chiu Li, M.D.
  OBJECTIVE: To investigate whether routine intracytoplasmic sperm injection (ICSI) has better laboratory outcomes than conventional in vitro fertilization (IVF) in couples with unexplained infertility.

STUDY DESIGN: A randomized study using sibling oocytes from 54 women with unexplained infertility (normal ovulation, semen parameters, and tuboperitoneal status using laparoscopy) who underwent IVF treatment in a university-based ART center. The sibling oocytes of each participant were randomly allocated to conventional IVF or ICSI in the order of their collection. Laboratory outcomes including fertilization rate and embryo quality were investigated. Fisher’s exact test was used for data analysis, and 2-sided value of p<0.05 was considered as statistically significant.

RESULTS: A total of 586 oocytes were retrieved, with 297 and 289 sibling oocytes in conventional IVF and ICSI groups, respectively. Although the ICSI group had a significantly higher fertilization rate per injected oocyte than conventional IVF (78.8% vs. 56.2%, p<0.05), there was no statistically significant difference in terms of fertilization rates (63% in ICSI vs. 56.2% in conventional IVF, p>0.05) and proportion of good-quality embryos (25.1% in ICSI vs. 21.6% in conventional IVF) per assigned oocyte.

CONCLUSION: As ICSI was not found to have laboratory outcomes superior to those of conventional IVF, its routine use in couples with unexplained infertility is not justified.
Keywords:  assisted reproductive technologies, fertilization, ICSI, in vitro fertilization, intracytoplasmic sperm injection, oocyte, unexplained infertility
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