In the latest HR Editor’s highlight, Professor Hans Evers questioned the usage, or rather the overusage, of ICSI in fertility treatments. He referred to the newly published world ART figures in the ICMART World Report on Assisted Reproductice Technologies from 2008-2010. This report covers over 4.5 million started cycles, with about twice as many ICSI as IVF. Although a method originally developed to treat male infertiliy, today it is clearly being used for many other indications – such as advanced maternal age – and to ensure fertilisation.
The provocative statement of Evers that “ICSI on faulty indications has prevented at least 25,000 couples from getting pregnant” has stimulated much discussion in recent weeks – and of course here at this congress. On Tuesday Julius Hreinsson, in a discussion of individualised or standard treatment in IVF, proposed that certain treatments – including ICSI – should not be offered as a standard treatment to all patients as it will not improve our results. ICSI, said Hreinsson, should only be offered as an individualised option in cases where the access of sperm is limited.
Further support for limiting the use of ICSI was also presented in a session on IVF laboratory quality and strategies. Samer Tannus presented data from a study showing that ICSI does not improve pregnancy and LBRs in women of advanced age with non-male factor infertility. ICSI is an invasive technique and it seems that the need to reconsider its use is greater than ever.
Susanna Apter, Deputy Co-ordinator of SIG Embryology