Should ICSI be the treatment of choice for all cases of in-vitro conception?

The objective of this study was to examine different clinical scenarios of in-vitro conception, viz. fertilization with conventional IVF, IVF with hig h insemination concentration (HIC) and intracytoplasmic sperm injection (IC SI), and assess on a sibling oocyte comparison the hypothesis that ICSI sho uld be performed in all cases requiring in-vitro conception, ICSI with husb and's spermatozoa had a higher incidence of fertilization as compared with IVF or IVF with HIC with donor spermatozoa (if previous failure of fertiliz ation had occurred) for unexplained infertility. Similarly, ICSI with husba nd's spermatozoa had as high an incidence of fertilization as IVF with dono r spermatozoa for patients with severe oligozoospermia, asthenozoospermia a nd/or teratozoospermia, even when the spermatozoa were not selected for the ir morphology, Two studies were performed to assess ICSI in potential oocyt e-related failure of IVF, viz. when fertilization occurred in >50% of oocyt es for one group of patients, and in <50% of oocytes in a second group. In both of these studies a significant proportion of the oocytes that failed t o fertilize with conventional IVF eventually fertilized after ICSI, The ove rall conclusion was that ICSI as a first option offers a higher incidence o f fertilization, maximizes the number of embryos and minimizes the risk of complete failure of fertilization for all cases requiring in-vitro concepti on. However, among other concerns, current knowledge of ICSI as an outcome procedure does not provide the confidence to use this process in all cases of IVF for the time being.