Researcher say that ICSI may be over-used in some countries

Barcelona, Spain: New figures on assisted reproduction technology (ART) in Europe show that there has been an explosion in the use of ICSI (intracytoplasmic sperm injection) to treat infertility, the 24th annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Barcelona heard today (Wednesday). Researchers believe that some countries may now be using the procedure too often. In 2005 – the most recent year for which data have been collected – there were 203 329 ICSI cycles. This was nearly double the figure for standard IVF cycles, which was 118 074 for the same year.

The distribution of IVF and ICSI has undergone a complete reversal from 65.3% for IVF and 34.75 for ICSI in 1997 (when ART data first started to be collected for Europe), to 36.7% for IVF to 63.3% for ICSI in 2005.

ICSI was first developed in 1992 as a way of treating infertility caused when a man either had a very low sperm count or poor sperm motility. Individual sperm are collected and injected directly into the woman's egg, thereby ensuring fertilisation. However, Professor Anders Nyboe Andersen, chairman of the ESHRE's European IVF monitoring consortium, said the current shift from IVF to ICSI could not be explained by a corresponding rise in the proportion of couples seeking treatment for male-related infertility.

"More than half of all ICSI cycles are now done in couples without a diagnosis of severe male factor infertility. It is being used increasingly when couples are classified as having mixed causes of infertility, unexplained fertility or because they are older – in their late 30s or early 40s," said Prof Nyboe Andersen.

"Nor is it the case that performing ICSI provides a better pregnancy rate per embryo transfer than IVF. For 2005, the pregnancy rates were almost exactly the same: 30.4% for IVF and 30.3% for ICSI. More importantly, clinical trials have shown that ICSI does not produce more pregnancies compared to IVF for indications other than those for severe male infertility."

As ICSI is a more complicated procedure than IVF, it is also more expensive. Different studies have reported that ICSI is between 10% and 30% more expensive than IVF.

Prof Nyboe Andersen said: "Huge differences in the rates of ICSI and IVF exist between countries, but we don't know why this should be. The Nordic countries, The Netherlands and the UK used ICSI to a low extent (40-44%); Austria, Belgium and Germany used it much more frequently (68.5-73%); and the southern European countries, such as Greece, Italy and Spain, used ICSI the most frequently (66-81%).

"It would appear that some countries are using ICSI excessively compared to IVF, despite the lack of medical evidence that it is beneficial to patients. As ICSI does not give higher pregnancy rates than IVF in couples where the infertility is not caused by male factors, and as it is more expensive, infertile couples and society may benefit from a less frequent use of ICSI in some of these countries."

Prof Nyboe Andersen said that one possible explanation for the increase in ICSI might be because doctors felt under pressure to show couples that they had tried every available procedure, including the most advanced, to achieve a pregnancy. "This is understandable, but except in cases of male factor infertility, ICSI is unnecessarily complicated and more expensive."

This is the ninth year that the ESHRE consortium has reported data on ART in Europe and in this time the number of cycles has more than doubled. Thirty countries contributed data for 2005, with 14 giving complete data from all their clinics. In 2005 there were 419 037 cycles of ART performed in Europe – a 14% increase on 2004 when 367 056 cycles were reported.

France (71 278), Germany (53 378), the UK (41 911), Spain (41 680) and Italy (34 541) perform the most number of cycles. In addition to the figures for IVF and ICSI, there were 79 140 cycles of frozen embryo transfers, 11 469 cycles of egg donation and 5 137 cycles of pre-implantation genetic diagnosis (PGD).

Source: European Society for Human Reproduction and Embryology