ICSI yields lower cumulative live birth rate than conventional IVF in non-male factor infertility

This retrospective cohort study used data from the Canadian Assisted Reproductive Technologies Registry (CARTR Plus) and Better Outcomes Registry & Network (BORN) to compare intracytoplasmic sperm injection (ICSI) with conventional IVF in patients with non-male factor infertility. The analysis included 140,252 retrieval cycles (35,251 IVF; 105,001 ICSI).

The primary outcome was cumulative live birth rate (cLBR) per retrieval. Conventional IVF was associated with a higher cLBR compared to ICSI (38.5% vs 36.3%). Secondary outcomes included normal fertilization (2PN), fertilization rate, utilizable embryos per retrieval, and cycles without live birth, but specific results for these were not reported.

Safety outcomes, including adverse events and tolerability, were not reported. The study did not report p-values or confidence intervals for the primary comparison, and limitations were not explicitly stated. As an observational study, causal conclusions cannot be drawn.

Clinicians should consider these findings as hypothesis-generating. For non-male factor infertility, conventional IVF may offer a slightly higher cumulative live birth rate, but individual patient factors and treatment context should guide decision-making.