The Case Against Intracytoplasmic Sperm Injection for All

While intracytoplasmic sperm injection (ICSI) is the most significant advance in assisted reproductive technology (ART) for the alleviation of male factor subfertility, its use has become increasingly widespread and indiscriminate in ART clinics, extending well beyond the reasons for its necessary application. But ICSI is not “better” than IVF using any established outcome metric. Indeed, available evidence indicates that ICSI yields fewer embryos per treatment cycle, embryos which may have impaired developmental potential compared to IVF-derived embryos. This chapter investigates the basis for the over-use of ICSI, and identifies risks to which couples are exposed by the unjustified use of ICSI: a debate that has been raging for two decades, and is now also extending into considerations of “andrological ignorance”, how ICSI has effectively blocked scientific advances in andrology, and how obligate ICSI has effectively transferred the treatment burden for male factor infertility to the female partner, who is expected to undergo possibly unnecessary controlled ovarian hyperstimulation, oocyte retrieval and embryo transfer procedures.