title: Intracytoplasmic sperm injection versus in vitro fertilization: a randomized controlled trial and a meta-analysis of the literature.
abstract: 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.
authors.affiliation: Center for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium. tournaye@az.vub.ac.be
authors.forename: Herman
authors.initials: H
authors.lastname: Tournaye
authors.forename: Greta
authors.initials: G
authors.lastname: Verheyen
authors.forename: Carola
authors.initials: C
authors.lastname: Albano
authors.forename: Michel
authors.initials: M
authors.lastname: Camus
authors.forename: Lisbet
authors.initials: L
authors.lastname: Van Landuyt
authors.forename: Paul
authors.initials: P
authors.lastname: Devroey
authors.forename: André
authors.initials: A
authors.lastname: Van Steirteghem
mesh_terms: 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