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Review
. 2020 Sep;37(9):2081-2092.
doi: 10.1007/s10815-020-01836-0. Epub 2020 Jun 24.

ALWAYS ICSI? A SWOT analysis

E Bosch  1 , J J Espinós  2   3 , F Fabregues  4 , J Fontes  5 , J García-Velasco  6 , J Llácer  7 , A Requena  6 , M A Checa  8 , J Bellver  9   10 ; Spanish Infertility SWOT Group (SISG)
Affiliations
Review

ALWAYS ICSI? A SWOT analysis

E Bosch et al. J Assist Reprod Genet. 2020 Sep.

Abstract

Purpose: Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI.

Methods: A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication.

Results: The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out.

Conclusion: Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.

Keywords: Assisted reproduction; In vitro fertilization (IVF); Infertility; Intracytoplasmic sperm injection (ICSI); Pregnancy; Severe non-male factor.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
A SWOT analysis of ICSI versus IVF for non-male factor infertility in assisted reproduction
See this image and copyright information in PMC

References

    1. Palermo GD, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992;340(8810):17–18. - PubMed
    1. Boulet SL, Mehta A, Kissin DM, Warner L, Kawwass JF, Jamieson DJ. Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection. JAMA. 2015;313:255–263. - PMC - PubMed
    1. Adamson GD, de Mouzon J, Chambers GM, Zegers-Hochschild F, Mansour R, Ishihara O, Banker M, Dyer S. International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011. Fertil Steril. 2018;110:1067–1080. - PubMed
    1. van Rumste MM, Evers JL, Farquhar CM. ICSI versus conventional techniques for oocyte insemination during IVF in patients with non-male factor subfertility: a Cochrane review. Hum Reprod. 2004;19(2):223–227. - PubMed
    1. Barrow P. Revision of the ICH guideline on detection of toxicity to reproduction for medicinal products: SWOT analysis. Reprod Toxicol. 2016;64:57–63. - PubMed