Expensive form of IVF is overused, says fertility journal editor

The editor-in-chief of Human Reproduction has criticised the overuse of ICSI (intracytoplasmic sperm injection), following a world report into the use of assisted reproductive technologies (ART).

The report, published in the same journal, finds that ICSI – a technique used during IVF for men with very low sperm counts – is used in almost 100 percent of IVF cycles in the Middle East and some parts of Latin America.

In an editorial in the journal, Professor Hans Evers of Maastricht University wrote: 'Unless the majority of couples' infertility in the world today is determined by severe male causes, the report offers a sobering confrontation with modern reproductive medicine practice.'

He added that there has been 'unjustified enthusiasm for ICSI on the part of patients and doctors' and that 'we have arrived in a situation of therapeutic illusion on a grand scale'.

The ICSI technique involves injecting a single sperm into an egg collected as part of an IVF cycle, but some studies have shown that it results in fewer live births than IVF alone when male infertility is not the problem.

'Intending to improve their patients' pregnancy probability by preventing fertilisation failure, well-meaning doctors actually decrease their chances. This has to stop. We have pledged to do no harm,' wrote Professor Evers. He goes on to say that doctors serve their patients best by making decisions based on the evidence 'not by playing Santa Claus and doling out nicely wrapped presents of unnecessary, ineffective and costly care'.

His editorial accompanies the latest report of the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), which has collected information on ART from between 58 and 61 countries from 2008, 2009 and 2010. The report finds that that, despite male infertility occurring in only 40 percent of couples receiving ART, ICSI is used in around 67 percent of treatment cycles.

In 2010, 455,000 ICSI treatments were started worldwide, compared with 220,000 IVF-only treatments. The report also highlights the disparity in the worldwide use of ICSI – it is used in almost 100 percent of treatment cycles in the Middle East compared with 65 percent of cycles in Europe.

There was 1.4 times as much ICSI than IVF in Asia, twice as much in sub-Saharan Africa, just over twice as much in Europe and 2.7 times as much in North America. In Latin America there was more than six times as much ICSI, and in the Middle East it was used more than 60 times as often.

Last week, fertility experts in the UK raised concerns about the use of 'add-on' treatments being used in private IVF clinics, without sufficient evidence for their effectiveness (see BioNews 852). Such treatments add to the already high costs of IVF treatment.