IVF-patients with nonmale factor "to ICSI" or "not to ICSI" that is the question?

Purpose: Intracytoplasmic sperm injection (ICSI) guarantees high fertilizat ion rates and could theoretically lead to higher implantation rates as well . Furthermore injection into oocyte creates a hole in the zona pellucida si milar to the procedure of assisted hatching. We were therefore interested t o assess such a potential benefit for infertile IVF patients without male f actor Materials and Methods: Open randomized prospective study according to the r ules "Good Clinical Practice" with informed consent of the patients and ins titutional review board approval. Ninety-one consecutively seen patients wi th tubal infertility or hostile cervical mucus were randomized to undergo e ither ICSI (44 patients) or IVF (45 patients). In two patients fertilizatio n of oocytes failed and so a repeated ICSI had to be performed. All these p atients were stimulated with tile same protocol, using the gonadotropin rel easing hormome-agonist (GnRH-a) buserelin acetate in an ultrashort flair-up protocol together with pure follicle stimulating hormone (rFSH). Tile two study groups did nor differ in terms of age BMI, and all baseline hormone l evels. Results: Tire total pregnancy rate was 42% in the normal IVF group with 33% ongoing pregnancies The ICSI group had a total pregnancy rate of 39% with 23% ongoing pregnancies. The implantation rate per transferred embryo was h igher for normal IVF but not significant (18% versus 11%). The variables fe rtilization rate age body mass index, base-line hormone levels, endometrial thickness, embryo score, and the highest grade embryo per transfer were ve ry similar in both groups. Conclusion: ICSI should be applied only when conventional IVF fails, that i s, for male factor patients and for patients with unexplained infertility.