Overuse of ICSI

Recent figures show that the use of ICSI (intracytoplasmic sperm injection), a technique used to treat infertility, is being used in Europe so often that some researchers now suspect overuse of this treatment. In the year 2005 alone, the technique was used 203,329 times. This is almost double the number of IVF cycles, which stood at 118,074 during the same time span.

These two infertility treatments, IVF and ICSI, have switched roles since 1997, when IVF was performed 65.3% of the time, and ICSI only 34.75%. In 2005, IVF used 36.7% of the time, whereas ICSI was employed 63.3% of the time.

Male Infertility

In 1992, ICSI was developed as a means of treating infertility where the cause was found to be poor sperm count or motility. Sperm are collected and injected straight into the woman’s egg, which ensures fertilization. Professor Anders Nyboe Andersen, chairman of the ESHRE’s (European Society of Human Reproduction and Embryology) European IVF monitoring consortium noted that the burgeoning use of ICSI could not be explained by a matching increase in the number of couples afflicted with male fertility issues. Prof. Anderson stated, “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.”

No Guarantee

The researcher also commented that ICSI does not guarantee a rate of pregnancy better than IVF. In 2005, for instance, the pregnancy rates for the two procedures were almost identical, with 30.4% for IVF and 30.3% for ICSI. In addition, it’s important to understand that the two techniques are not interchangeable, and ICSI is inappropriate when the cause of infertility originates with the woman. Furthermore, ICSI is a more complex procedure and is 10-30% more expensive than IVF.

The breakdown of the figures shows huge differences in the rates of ICSI and IVF depending on which European country is cited. In the Netherlands, the Nordic countries, and the UK, ICSI is not as overused at only 40-44%; Germany, Belgium, and Germany, use it often at 68.5-73%; while southern European countries like Spain, Italy, and Greece are really gung-ho on the technique with a rate of 66-81%.

Prof. Anderson believes the trend for ICSI may be due to the pressure placed on doctors to prove they have left no stone unturned in the quest for producing pregnancies. ESHRE has held its consortium on ART for a total of nine years during which time the number of cycles undergone by couples has more than doubled. Thirty countries participated by providing data for the year 2005, with 14 of them giving data from each and every existing clinic. During 2005, 419,037 cycles of ART were performed in Europe, which shows an increase of 14% from the previous year’s figure of 367, 056 cycles.

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