Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-2jptb Total loading time: 0 Render date: 2025-02-19T23:41:53.021Z Has data issue: false hasContentIssue false

Chapter 11 - The Case Against Intracytoplasmic Sperm Injection for All

Published online by Cambridge University Press:  24 May 2020

By
David Mortimer  and
Sharon T. Mortimer
Edited by
R. John Aitken ,
David Mortimer  and
Gabor Kovacs
R. John Aitken
Affiliation:
University of Newcastle, New South Wales
David Mortimer
Affiliation:
Oozoa Biomedical Inc, Vancouver
Gabor Kovacs
Affiliation:
Epworth Healthcare Melbourne
Get access

Summary

While intracytoplasmic sperm injection (ICSI) is the most significant advance in assisted reproductive technology (ART) for the alleviation of male factor subfertility, its use has become increasingly widespread and indiscriminate in ART clinics, extending well beyond the reasons for its necessary application. But ICSI is not “better” than IVF using any established outcome metric. Indeed, available evidence indicates that ICSI yields fewer embryos per treatment cycle, embryos which may have impaired developmental potential compared to IVF-derived embryos. This chapter investigates the basis for the over-use of ICSI, and identifies risks to which couples are exposed by the unjustified use of ICSI: a debate that has been raging for two decades, and is now also extending into considerations of “andrological ignorance”, how ICSI has effectively blocked scientific advances in andrology, and how obligate ICSI has effectively transferred the treatment burden for male factor infertility to the female partner, who is expected to undergo possibly unnecessary controlled ovarian hyperstimulation, oocyte retrieval and embryo transfer procedures.

Keywords

Intracytoplasmic sperm injection; ICSI; andrologyinfertilitytreatmentoutcomesrisks
Type
Chapter
Information
Male and Sperm Factors that Maximize IVF Success , pp. 130 - 140
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fishel, S., Aslam, I., Lisi, F., Rinaldi, L., Timson, J., Jacobson, M., et al. (2000) Should ICSI be the treatment of choice for all cases of in-vitro conception? Hum Reprod 15:1278–1283.Google Scholar
Ola, B., Afnan, M., Sharif, K., et al. (2001) Should ICSI be the treatment of choice for all cases of in-vitro conception? Considerations of fertilization and embryo development, cost-effectiveness and safety. Hum Reprod 16:2485–2490.CrossRefGoogle ScholarPubMed
World Health Organization (2010) WHO Laboratory Manual for the Examination and Processing of Human Semen. Geneva: World Health Organization.Google Scholar
Schatten, G., Hewitson, L., Simerly, C., Sutovsky, P. and Huszar, G. (1998) Cell and molecular biological challenges of ICSI: ART before science? J Law Med Ethics 26:29–37.Google Scholar
Varghese, A. C., Goldberg, E. and Agarwal, A. (2007) Current and future perspectives on intracytoplasmic sperm injection: a critical commentary. Reprod Biomed Online; 15:719–727.CrossRefGoogle ScholarPubMed
Carrell, D. T., Nyboe Andersen, A. and Lamb, D. J. (2015) The need to improve patient care through discriminate use of intracytoplasmic sperm injection (ICSI) and improved understanding of spermatozoa, oocyte and embryo biology. Andrology 3:143–146.CrossRefGoogle ScholarPubMed
Evers, J. L. H. (2016) Santa Claus in the fertility clinic. Hum Reprod 31:1381–1382.CrossRefGoogle ScholarPubMed
Barratt, C. L. R., De Jonge, C. J. and Sharpe, R. M. (2018) “Man Up”: the importance and strategy for placing male reproductive health centre stage in the political and research agenda. Hum Reprod 33:541–545.CrossRefGoogle Scholar
van Rumste, M. M. E, Evers, J. L. H. and Farquhar, C. (2003) Intra-cytoplasmic sperm injection versus conventional techniques for oocyte insemination during in vitro fertilisation in couples with non-male subfertility. Cochrane Database of Systematic Reviews 2. CD001301Google Scholar
Kim, H. H., Bundorf, M. K., Behr, B. and McCallum, S. W. (2007) Use and outcomes of intracytoplasmic sperm injection for non-male factor infertility. Fertil Steril 88:622–628.Google Scholar
Nyboe Andersen, A., Carlsen, E. and Loft, A. (2008) Trends in the use of intracytoplasmatic sperm injection marked variability between countries. Hum Reprod Update 14:593–604.CrossRefGoogle ScholarPubMed
ESHRE (2017) Special Interest Group of Embryology and Alpha Scientists in Reproductive Medicine. The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators. Reprod Biomed Online 35:494–510.Google Scholar
Borini, A., Gambardella, A., Bonu, M, A., et al. (2009) Comparison of IVF and ICSI when only few oocytes are available for insemination. Reprod Biomed Online 19:270–275.Google Scholar
Tannus, S., Son, W. Y., Gilman, A., Younes, G., Shavit, T. and Dahan, M. H. (2017) The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age. Hum Reprod 32:119–124.Google Scholar
ASRM (2012) The practice committees of the American Society for Reproductive Medicine and Society for Assisted Reproductive Technology. Intracytoplasmic Sperm Injection (ICSI) for non-male factor infertility: a committee opinion. Fertil Steril 98:1395–1399.CrossRefGoogle Scholar
Mortimer, D., Dufton, M. and MacDonald, J. (2015) Minimizing Failed and Low IVF Fertilization Rates: Refuting The Concept of “ICSI for All” to Avoid Poor Outcomes. Halifax, NS: Canadian Fertility and Andrology Society, October 2015. Abstract SC01.Google Scholar
Björndahl, L., Mortimer, D., Barratt, C. L. R., Castilla, J. A., Menkveld, R., Kvist, U., et al. (2001) A Practical Guide to Basic Laboratory Andrology. Cambridge, UK: Cambridge University Press.Google Scholar
Griffiths, T. A., Murdoch, A. P. and Herbert, M. (2000) Embryonic development in vitro is compromised by the ICSI procedure. Hum Reprod 15:1592–1596.CrossRefGoogle ScholarPubMed
Shoukir, Y., Chardonnens, D., Campana, A. and Sakka, D. (1998) Blastocyst development from supernumerary embryos after intracytoplasmic sperm injection: a paternal influence? Hum Reprod 13:1632–1637.CrossRefGoogle ScholarPubMed
Bridges, P. J., Jeoung, M., Kim, H., Kim, J. H., Lee, D. R., Ko, C., et al. (2011) Methodology matters: IVF versus ICSI and embryonic gene expression. Reprod Biomed Online 23:234–244.CrossRefGoogle ScholarPubMed
Bhattacharya, S., Hamilton, M. P., Shaaban, M., Khalaf, Y., Seddler, M., Ghobara, T., et al. (2001) Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial. Lancet 357:2075–2079.CrossRefGoogle ScholarPubMed
Li, Z., Wang, A. Y., Bowman, M., Hammarberg, K., Farquhar, C., Johnson, L., et al. (2018) ICSI does not increase the cumulative live birth rate in non-male factor infertility. Hum Reprod 33:1322–1330.CrossRefGoogle Scholar
Boulet, S. L., Mehta, A., Kissin, D. M., Warner, L., Kawwass, J. F. and Jamieson, D. J. (2015) Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection. JAMA 313:255–263.CrossRefGoogle ScholarPubMed
SART (2016) Society for Assisted Reproductive Technology. SART Clinic Summary Report 2013. www.sartcorsonline.com (membership required for access).Google Scholar
Dyer, S., Chambers, G. M., de Mouzon, J., Nygren, K. G., Zegers-Hochschild, F., Mansour, R., et al. (2016) International Committee for Monitoring Assisted Reproductive Technologies world report: Assisted Reproductive Technology 2008, 2009 and 2010. Hum Reprod 31:1588–1609.Google Scholar
De Geyter, C., Calhaz-Jorge, C., Kupka, M. S., Wyns, C., Mocanu, E., Motrenko, T., et al. (2018) ART in Europe, 2014: results generated from European registries by ESHRE. Hum Reprod 33:1586–1601.Google Scholar
Mortimer, D. (1999) Structured management as a basis for cost-effective infertility care. In Gagnon, C. (ed.) The Male Gamete: From Basic Science to Clinical Applications. Vienna, IL, Cache River Press. 363–370.Google Scholar
Mortimer, D. (1995) Sperm transport in the female genital tract. In Grudzinskas., J. G. and Yovich, J. L. (eds.) Gametes: The Spermatozoon. Cambridge, Cambridge University Press. 157–174.Google Scholar
Franken, D. R. and Bastiaan, H. S. (2009) Can a cumulus cell complex be used to select spermatozoa for assisted reproduction? Andrologia 41:369–376.CrossRefGoogle ScholarPubMed
Sakkas, D., Ramalingam, M., Garrido, N. and Barratt, C. L. (2015) Sperm selection in natural conception: what can we learn from Mother Nature to improve assisted reproduction outcomes? Hum Reprod Update 21:711–726.Google Scholar
Miller, D. (2018) Hyaluronic Acid Binding Sperm Selection for ICSI (HABSelect): Study Outcomes And Conclusions., Liverpool, UK: Fertility UK.Google Scholar
Harper, J., Jackson, E., Sermon, K., Aitken, R. J., Harbottle, S., Mocanu, E., et al. (2017) Adjuncts in the IVF laboratory: where is the evidence for “add-on” interventions? Hum Reprod 32:485–491.CrossRefGoogle ScholarPubMed
Fleming, S. D., Ilad, R. S., Griffin, A. M., Wu, Y., Ong, K. J., Smith, H. C., et al. (2008) Prospective controlled trial of an electrophoretic method of sperm preparation for assisted reproduction: comparison with density gradient centrifugation. Hum Reprod 23:2646–2651.CrossRefGoogle ScholarPubMed
Quinn, M. M., Jalalian, L., Ribeiro, S., Ona, K., Demirci, U., Cedars, M. I., et al. (2018) Microfluidic sorting selects sperm for clinical use with reduced DNA damage compared to density gradient centrifugation with swim-up in split semen samples. Hum Reprod 33:1388–1393.Google Scholar
Mortimer, D. (2000) Sperm preparation methods. J Androl 21:357–366.Google Scholar
Mortimer, D. and Mortimer, S. T. (2013) Density gradient separation of sperm for artificial insemination. Methods Mol Biol 927:217–226.Google Scholar
Berkovitz, A., Eltes, F., Lederman, H., Peer, S., Ellenbogen, A., Feldberg, B., et al. (2006) How to improve IVF-ICSI outcome by sperm selection. Reprod Biomed Online 12:634–638.Google Scholar
Davies, M. J., Moore, V. M., Willson, K. J., Van Essen, P., Priest, K., Scott, H., et al. (2012) Reproductive technologies and the risk of birth defects. N Engl J Med 366:1803–1813.Google Scholar
Mortimer, D. (2018) The functional anatomy of the human spermatozoon: relating ultrastructure and function. Mol Hum Reprod 24:567–592.Google Scholar
Tateno, H. (2009) Possible causal factors of structural chromosome aberrations in intracytoplasmic sperm injection of the mouse. Reprod Med Biol 8:89–95.Google Scholar
Moreira, P. N., Fernández-González, R., Rizos, D., Ramirez, M., Perez-Crespo, M. and Gutiérrez-Adán, A. (2005) Inadvertent transgenesis by conventional ICSI in mice. Hum Reprod 20:3313–3317.CrossRefGoogle ScholarPubMed
Moisyadi, S., Kaminski, J. M. and Yanagimachi, R. (2009) Use of intracytoplasmic sperm injection (ICSI) to generate transgenic animals. Comp Immunol Microbiol Infect Dis 32:47–60.CrossRefGoogle ScholarPubMed
Rawe, V. Y., Olmedo, S. B., Nodar, F. N., et al. (2000) Cytoskeletal organization defects and abortive activation in human oocytes after IVF and ICSI failure. Mol Hum Reprod 6:510–516.Google Scholar
Hewitson, L., Dominko, T., Takahashi, D., Martinovich, C., Ramalho-Santos, J., Sutovsky, P., et al. (1999) Unique checkpoints during the first cell cycle of fertilization after intracytoplasmic sperm injection in rhesus monkeys. Nat Med 5:431–433.Google Scholar
Hewitson, L., Simerly, C. and Schatten, G. (2000) Cytoskeletal aspects of assisted fertilization. Semin Reprod Med 18:151–159.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×