ALWAYS ICSI? A SWOT analysis
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REVIEW
ALWAYS ICSI? A SWOT analysis E. Bosch 1 & J. J. Espinós 2,3 & F. Fabregues 4 & J. Fontes 5 & J. García-Velasco 6 & J. Llácer 7 & A. Requena 6 & M. A. Checa 8 & J. Bellver 1,9 & on behalf of the Spanish Infertility SWOT Group (SISG) Received: 25 February 2020 / Accepted: 17 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. Methods A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. Results The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. Conclusion Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility. Keywords Intracytoplasmic sperm injection (ICSI) . In vitro fertilization (IVF) . Severe non-male factor . Pregnancy . Assisted reproduction . Infertility
Introduction * E. Bosch [email protected] 1
IVI RMA Valencia, Plaza de la Policía Local, 3, 46015 Valencia, Spain
2
Fertty, Ausiàs March 25, 08010 Barcelona, Spain
3
Universidad Autónoma de Barcelona, Campus de la UAB, Plaza Cívica, s/n, 08193 Bellaterra (Barcelona), Spain
4
Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, C/Villarroel 160, 08036 Barcelona, Spain
5
Hospital Universitario Virgen de las Nieves, Avd Fuerzas Armadas s/n, 18014 Granada, Spain
6
IVI RMA Madrid, Avda. del Talgo 68, 28023 Madrid, Spain
7
Instituto Bernabeu Alicante, Av. Albufereta, 31, 03540 Alacant (Alicante), Spain
8
Hospital del Mar-Parc de Salut Mar, Paseo Maritimo 25-29, 08005 Barcelona, Spain
9
Departamento de Pediatría, Obstetricia y Ginecología. Facultad de Medicina, Universidad de Valencia, Valencia, Spain
Intracytroplasmatic sperm injection (ICSI) is an assisted fertilization method where a single spermatozoon is injected into a mature oocyte. ICSI was introduced in 1992 as a way to treat couples with severe male infertility [1]. However, o
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