Intracytoplasmic sperm injection versus in vitro fertilization: a randomized controlled trial and a meta-analysis of the literature.
OBJECTIVE
To compare ICSI with IVF using two insemination concentrations in moderate male infertility and to compare these data with other randomized controlled trials (RCTs).


METHODS
Prospective, randomized, controlled trial and meta-analysis.


METHODS
University-based tertiary referral center.


METHODS
Seventy-three couples undergoing ART.


METHODS
In one IVF group a standard insemination concentration of 0.2 x 10(6)/mL was used, whereas in the other group a high insemination concentration (HIC) of 0.8 x 10(6)/mL was used. Each protocol was compared with ICSI on sibling oocytes.


METHODS
Fertilization, fertilization failure, and embryonic development.


RESULTS
The overall fertilization rate was significantly lower after standard IVF than after ICSI: 37.4% vs. 64.3%. Where HIC IVF was used, the overall fertilization rate was not significantly different from that after ICSI: 59.6% vs. 67.6%. Eight randomized controlled trials were selected and reviewed together with the present randomized controlled trial by meta-analysis. The risk ratio for an oocyte to become fertilized was 1.9 (95% confidence interval of 1.4 to 2.5) in favor of ICSI, and 3.1 ICSI cycles may be needed to avoid one complete fertilization failure after conventional IVF (95% CI of 1.7 to 12.4).


CONCLUSIONS
The data from this study and the meta-analysis show that ICSI is a more efficient technique in terms of fertilization, but not in comparison with HIC IVF.
Tournaye
Herman
H
Center for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium. tournaye@az.vub.ac.be
Verheyen
Greta
G
Albano
Carola
C
Camus
Michel
M
Van Landuyt
Lisbet
L
Devroey
Paul
P
Van Steirteghem
André
A
D000328:Adult; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D013076:Sperm Count; D020554:Sperm Injections, Intracytoplasmic