Intracytoplasmic Sperm Injection Does Not Improve Reproductive Outcomes

Sheree L. Boulet, DrPH, MPH Division of Reproductive Health Centers for Disease Control and Prevention, Atlanta, Interview with:
Sheree L. Boulet, DrPH, MPH

Division of Reproductive Health
Centers for Disease Control and Prevention, Atlanta, Georgia

Medical Research: What is the background for this study? What are the main findings?
Dr. Boulet:  Intracytoplasmic Sperm Injection is generally considered a safe and effective treatment for male factor infertility; however, some studies have shown that ICSI is increasingly used in patients without male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF). In addition to increasing the cost of an IVF cycle, use of  Intracytoplasmic Sperm Injection has been found to increase the risk for adverse infant outcomes such as birth defects, chromosomal abnormalities and autism. Using data from CDC’s National Assisted Reproductive Technology Surveillance System, we found that use of ICSI increased by fourfold from 1996 through 2012 (from 15.4% to 66.9%). Furthermore, we found that use of  Intracytoplasmic Sperm Injection did not improve reproductive outcomes such as rates of pregnancy, miscarriage and live birth, when compared with conventional IVF, regardless of whether male factor infertility was present.

Medical Research: What should clinicians and patients take away from your report?

Dr. Boulet: The use of Intracytoplasmic Sperm Injection is increasing for all types of IVF cycles, and especially for cycles without a diagnosis of male factor infertility. Our findings suggest that  Intracytoplasmic Sperm Injection did not result in improved reproductive outcomes. Therefore, the risks and benefits of using ICSI should be carefully considered.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Boulet: Additional studies are needed to compare outcomes for cycles using Intracytoplasmic Sperm Injection versus those using conventional IVF for specific non-male factor indications such as poor quality oocytes or advanced maternal age. In addition, more studies are needed to evaluate the safety of Intracytoplasmic Sperm Injection in the context of non-male factor infertility, particularly as it relates to infant outcomes such as birth defects and developmental disabilities.


Boulet SL, Mehta A, Kissin DM, Warner L, Kawwass JF, Jamieson DJ. Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection. JAMA. 2015;313(3):255-263. doi:10.1001/jama.2014.17985.

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