Clinics Might Be Overusing Sperm Injection Method In Fertility Treatments, Study Says

Main Category: Fertility
Also Included In: Women's Health / Gynecology;  Pregnancy / Obstetrics
Article Date: 23 Jul 2007 - 9:00 PDT

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Fertility clinics might be overusing a laboratory technique called intracytoplasmic sperm injection despite the technique's additional cost, uncertain efficacy and risks, according to a study published Thursday in the New England Journal of Medicine, the AP/Seattle Post-Intelligencer reports (Stobbe, AP/Seattle Post-Intelligencer, 7/18).

ICSI is a process in which a single sperm is placed into an egg using a syringe, and it is used when a man has a low semen count or poor sperm quality (Kaiser Daily Women's Health Policy Report, 7/3). The technique adds about $1,500 to the $12,400 average cost of an in vitro fertilization treatment cycle, the study's authors said (AP/Seattle Post-Intelligencer, 7/18).

For the study, Tarun Jain, assistant professor of reproductive endocrinology and infertility at the University of Illinois-Chicago, and colleagues examined data from 1995 to 2004 on fertility treatments at U.S. clinics. The study looked at all IVF cycles involving new embryos from nondonor eggs in women younger than age 43, HealthDay/Forbes reports.

According to the study, the percentage of IVF treatment cycles that used ICSI increased from 11% in 1995 to 57.5% in 2004 (HealthDay/Forbes, 7/18). Researchers also found that the proportion of couples who had difficulty conceiving because the man's sperm remained at 34% throughout the study period. The study also showed that among IVF attempts with successful egg retrievals in 2004, about 31% that used ICSI resulted in a live birth, compared with 33% for those that did not use the technique.

The study showed a higher risk of birth defects among infants conceived through ICSI, but the researchers said they are unclear whether it is the result of the technique or abnormalities in the fathers' sperm (AP/Seattle Post-Intelligencer, 7/18). In addition, researchers found that ICSI rates were higher in states where insurance coverage of the technique is mandated -- including Illinois, Massachusetts and Rhode Island -- than in states without mandated coverage.

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"Despite its added cost and uncertain efficacy and risk, the use of ICSI has been extended to include patients without documented male-factor infertility," Jain said in a statement. He added that further studies are "needed to better understand the proper role of ICSI," and that "guidelines may be useful to determine what the best indications are for the use of the technology in patients without male-factor infertility" (HealthDay/Forbes, 7/18). Jain noted that he did not have specific data about each couple or each treatment attempt, making it difficult to determine whether clinics that frequently performed ICSI also had disproportionate numbers of patients with more severe cases.

Steve Ory, president of the American Society of Reproductive Medicine, said that there are several reasons a clinic might use ICSI to treat an infertile couple, and that it is unclear whether the technique is being overused. According to the researchers and Ory, some clinics might use ICSI in cases where there are only a few eggs available or in cases where traditional IVF failed. Some clinics might choose to use it for all couples, believing it can increase the chance of success, the AP/Post-Intelligencer reports. "There's a lot of art to this," Ory said. Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics, said, "This paper is particularly troubling because we've got a major shift in practice that isn't evidence driven. The paper suggests it may be driven by money" (AP/Seattle Post-Intelligencer, 7/18).

The study is available online.

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