ICSI 'ineffective and costly’
Monday May 23rd, 2016
The increase in intracytoplasmic sperm injection (ICSI) for infertility treatment has been attacked by a world-leading fertility expert.
Professor Hans Evers, editor in chief of Human Reproduction, said that doctors are guilty of over-estimating the effect of ICSI, which was originally developed for male infertility.
Writing in response to the latest world report on assisted reproductive technologies (ART), he said: “The majority of the patients who will get pregnant with intracytoplasmic sperm injection will also do so with IVF.”
Previous studies have shown that ICSI results in fewer live births than IVF in couples for whom male infertility is not the problem.
“Intending to improve their patients' pregnancy probability by preventing fertilisation failure, well-meaning doctors actually decrease their chances. This has to stop. We have pledged to do no harm,” he writes.
He added that doctors would do better to make decisions based on the evidence, “not by playing Santa Claus and doling out nicely wrapped presents of unnecessary, ineffective and costly care”.
He was responding to a report in Human Reproduction, which reveals that the use of ICSI has levelled off in some regions, but is used almost all the time in the Middle East and Latin America.
The report, which examines global ART in 2008, 2009, and 2010, includes data from nearly 2,500 ART clinics from between 58 and 61 countries. It is the first time that the report has included all regions of the world and it also includes for the first time data from some sub-Saharan African countries.
During the three years being examined, more than 4,461,300 ART cycles were carried out globally, which resulted in about 1.1 million babies being born.
While ART use was fairly constant, with 436 cycles per million of the population in 2008 and 474 cycles per million in 2010, huge variations were among different countries.
In Israel, there were 4,775 cycles per million compared to just eight cycles per million in the Dominican Republic in 2010.
In the same year there were almost 2,500 cycles per million in Australia and New Zealand, more than 900 per million in Europe, 570 cycles per million in North America, 150 cycles per million in Latin America and nearly 90 cycles per million in sub-Saharan Africa.
There was also an increase in the number of single embryos transferred per cycle, from 25.7% in 2008 to 30% in 2010. The average number of embryos transferred fell from 2.1 to 1.9 and the rates of twin and triplet births also fell. Frozen embryo transfer (FET) increased by 27.6% between 2008 and 2010.
First author Professor Silke Dyer, from the Department of Obstetrics and Gynaecology, at Groote Schuur Hospital and the University of Cape Town, South Africa, said: "The move towards single embryo transfer (SET) and thus towards greater safety and better outcome for ART is a significant finding.
“We must acknowledge that this approach carries additional cost. However, given that the optimal outcome of fertility treatment is a healthy single live birth, supportive funding meets the dual goals of equitable access to treatment and safer outcomes for ART-conceived children and mothers. The global multiple birth rate of 21.5% in 2010 is still too high, and policy and practice should seek to reduce the multiple birth rates.”
S Dyer et al. International Committee for Monitoring Assisted Reproductive Technologies - world report on assisted reproductive technologies: 2008-2009-2010. Human Reproduction. May 2016. doi:10.1093/humrep/dew082.
Evers JLH. Santa Claus in the fertility clinic. Human Reproduction. May 2016. doi:10.1093/humrep/dew092 [abstract]
Tags: Childbirth and Pregnancy | Women's Health & Gynaecology | World Health
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