The Indication of ICSI

Abstract

The indication of ICSI is generally based on sperm analysis, past therapeutic history, and prediction of fertilization failure. In this study, we attempted to evaluate the usefulness of SMI (Sperm Motility Index) and "split cycle" procedure on ICSI indication. According to SMI score, patients were separated into three groups: I) Poor (0≤SMI<80, n=10), II) Medium (80≤SMI<160, n=9), III) Good (160≤SMI, n=43). Among these, no significant difference was observed in fertilization rates (Poor 56.4%, Medium 69.6%, and Good 71.1%) or in pregnancy rates (20.0%, 33.3%, and 48.8%, respectively). On the other hand, patients were separated into three groups: I) conventional IVF (n=188), II) split cycle (n=14), III) ICSI (n=72). Among these, no significant difference was observed in fertilization rates (conventional IVF 64.8%, split cycle 63.0%, and ICSI 56.0%) or in pregnancy rates (46.6%, 57.1%, and 31.7%, respectively). Surprisingly, among those in split cycle who had had fertilization failure on previous conventional IVF trial, no significant difference was found in fertilization rates between conventional IVF eggs and ICSI eggs. In such cases, split cycle might be a better choice.