ICSI versus IVF in couples in whom the male partners had a semen analysis within normal reference ranges: An open debate.

During recent decades, the application of intracytoplasmic sperm injection (ICSI) has increased considerably worldwide, especially in couples with non-male factor infertility. However, several studies analysing the broad use of ICSI, even in cases with a normal semen analysis, have collectively demonstrated no benefits compared to conventional in-vitro fertilization (IVF). Currently, there is insufficient evidence to support the ICSI technique versus IVF in cases of poor ovarian response or a low number of oocytes collected, or in patients with advanced maternal age. Since the ICSI technique is more operator-dependent and invasive, its use should only be recommended in cases of male-factor infertility. There is some evidence showing that ICSI is linked with an increased risk of birth defects. Albeit this evidence is limited, and currently it is not possible to draw a firm conclusion on these concerns, we do believe that these risks should be rigorously investigated. Thus, this review aims to clarify the debate on the application of the ICSI procedure, as compared to standard IVF, in those ART cycles without a clear male factor infertility. Furthermore, we try to clarify whether ICSI would result in a higher live birth rate than IVF, in couples with non-male factor infertility. This article is protected by copyright. All rights reserved.