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Half of all ICSI cycles unnecessary, European figures show

9 July 2008
Appeared in BioNews 466

Data presented at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) shows that the number of cycles carried out annually in Europe has more than doubled since records began in 1997, when 200,000 cycles were carried out compared to 420,000 in 2005 - the most recent year for which data have been collected.

In particular, the data highlighted an explosion in the use of ICSI (intracytoplasmic sperm injection) to treat infertility, leading to fears that this expensive treatment is being used to excess.   63.3 percent of all cycles carried out in 2005 used ICSI rather than standard IVF, a complete reversal of the situation when records began in 1997 and ICSI was only used in 34.75 percent of cases.

ICSI - a twist on IVF in which a single sperm is injected directly into an egg - is used for treating male infertility caused by low sperm count or motility, when sperm is too weak or malformed to swim towards and fertilise the egg. 'More than half of all ICSI cycles are now done on couples without a diagnosis of severe male factor infertility,' said Professor Nyboe Anderson, chairman of ESHRE's European IVF monitoring consortium, believing that the technique is now used 'excessively'.

The technique is between 10 and 30 percent more expensive than standard IVF and has no impact on pregnancy rates other than for severe male infertility leading some experts to suggest that clinicians may be using it needlessly, perhaps to treat older patients, those with unexplained infertility or even simply to reassure patients that they have exhausted every possible avenue or tried the latest technologies. 'This is understandable, but except in cases of male factor infertility, ICSI is unnecessary and more expensive,' warned Professor Anderson.

As in previous years, the UK performed badly in terms of service provision, coming twelfth out of the 14 European countries that provided data for 2005, with only Montenegro, Croatia and Germany performing fewer cycles of fertility treatment per head of population.

The incidence of multiple pregnancies has continued to fall, reflecting a change in policy for most countries towards single or double embryo transfer. Only eastern European countries were reported to routinely transfer more than two embryos, where multiple pregnancies are often avoided by fetal reduction. As a result, the number of multiple births resulting from assisted reproduction techniques has continued to decline, reaching a record low of 82 per cent in 2005.

Worldwide ART data was also presented showing that three and a half million babies have been born using IVF and other assisted reproductive technologies (ART) since the world's first IVF baby was born in 1978.

Data were first collected on the number of ART births worldwide in 1989 - and in that year only about 30,000 babies were born following ART. This year's data, from the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), includes reports from 54 countries, and covers almost 750,000 IVF cycles and 120,000 newborn babies. The ICMART report covers two-thirds of the world's ART activity, so the total number of ART cycles in the world can be estimated at 1.3 million a year, and the number of babies produced at around 200,000 a year, said ICMART member Dr Jacques de Mouzon. As yet, the data does not include information on most African nations or many Asian countries.

As in previous years, the report highlighted the huge variation that exists in availability of ART treatments - and their success rates - across the countries represented. It also showed a continuing increase in the number of women over 40 being treated, with around 20 per cent of all fresh ART cycles in North America (18.7 per cent) and Australia (21.2 per cent) being carried out on women in this category.

SOURCES & REFERENCES
Concern over popular ICSI infertility treatment
The Times |  9 July 2008
Doctors concerned over popular IVF
PA |  9 July 2008
Researcher say that ICSI may be over-used in some countries
EurekaAlert |  9 July 2008
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