Pregnancy and neonatal outcomes of intracytoplasmic sperm injection versus in vitro fertilization in fresh cycles of women with advanced maternal age and nonmale factor infertility: A cross-sectional study.

Zare Garizi S, Sabagh Nezhad Yazd N, Nasim Tabibnejad, Dehghani-Firouzabadi R
International journal of reproductive biomedicine · 2025 · doi:10.18502/ijrm.v23i1.18190 · PMID:40190452 · PMC11966213
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This cross-sectional study of women with advanced maternal age and nonmale factor infertility found that IVF cycles yielded significantly higher fertilization, implantation, and chemical pregnancy rates compared to ICSI.

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This retrospective cross-sectional study analyzed pregnancy and neonatal outcomes for 1090 women over age 35 with nonmale factor infertility undergoing fresh embryo transfer cycles at an Iranian reproductive institute. The data revealed that conventional in vitro fertilization yielded significantly higher rates of successful fertilization, implantation, and chemical pregnancy compared to intracytoplasmic sperm injection, while also producing twins with higher birth weights and lower prematurity rates. Although the study found no statistically significant association between advancing maternal age and adverse outcomes like live birth failure or stillbirth, it highlights potential risks associated with routine ICSI use in patients without male factor infertility. Relevance to endometriosis and adenomyosis: listed as one indication for assisted reproductive technologies, though the paper's main focus is general infertility management rather than these specific conditions.

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Abstract

BackgroundIntracytoplasmic sperm injection (ICSI) was originally developed to facilitate fertilization in situations of severe male infertility. However, it is now frequently used for nonmale factor infertility, such as advanced maternal age or low oocyte count, despite the clinical advantages of this method has not been proven for these situations.ObjectiveThis study aims to compare pregnancy and neonatal outcomes between ICSI and in vitro fertilization (IVF) cycles in women with advanced maternal age and nonmale factor infertility.Materials and methodsThis retrospective cross-sectional study included 1090 women with nonmale factor infertility, who underwent fresh embryo transfer cycles of IVF or ICSI at the Yazd Reproductive Sciences Institute, Yazd, Iran between April 2018 and June 2023. Data on demographic characteristics, clinical outcomes, and neonatal outcomes were analyzed from electronic medical records.ResultsWomen undergoing IVF demonstrated significantly higher outcomes in fertilization, implantation, and chemical pregnancy rate (p < 0.05). Neonatal outcomes showed significantly higher twin birth weights and lower prematurity rates in the IVF group compared to the ICSI group (p < 0.001 and p = 0.011, respectively).ConclusionThis study suggests that IVF may yield better maternal outcomes and more favorable neonatal results than ICSI for older women with nonmale factor infertility. These results emphasize the significance of tailored treatment plans and the necessity for continued research to enhance assisted reproductive technologies techniques.
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N. Tabibnejad and S. Zare Garizi, designed the study and conducted the research. Monitoring, evaluating, and analyzing the data were done by all authors. Also, all authors reviewed the article, approved the final manuscript, and take responsibility for the integrity of the data. To ensure fairness and accurately reflect contributions, this article designates 2 corresponding authors, who jointly designed the study, conducted the data analysis, and contributed to drafting the manuscript. This dual authorship structure for both corresponding authors is essential to acknowledge the balanced and collaborative efforts that were central to this study's success.

Coi Statement

The authors declare that there is no conflict of interest.

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