Intracytoplasmic sperm injection hampers fertilization rate and pregnancy per initiated cycle in patients with extremely poor ovarian response.

PURPOSE: To compare the clinical outcomes of extremely poor responders with one or two oocytes who receive in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

METHODS

A retrospective study was carried out on 2572 patients with one or two oocytes retrieved from 2013 to 2022, of which 2159 patients were scheduled to receive IVF treatment and 413 patients were scheduled to receive ICSI treatment. The laboratory parameters and clinical outcomes were compared with adjusted multivariate regression and propensity score (PS) matching.

RESULTS

In both matched and non-matched cohorts, The ICSI group had a significantly higher total fertilization failure (TFF) rate and lower multiple fertilization rate than the IVF group (P < 0.05). After matching, the cumulative pregnancy rate per initiated cycle in the IVF group was significantly higher than in the ICSI group (28.7% vs 21.7, P < 0.05). However, the difference in cumulative live births did not reach statistical significance (21.2% vs 17.2%, P > 0.05). The adjusted odds ratios for TFF, cumulative pregnancy, and cumulative live birth comparing ICSI versus IVF in multivariate models were 1.65(95% CI: 1.12, 2.43), 0.65(95% CI: 0.46, 0.91), and 0.76(95% CI: 0.55, 1.04), respectively.

CONCLUSION

In poor responders with one or two oocytes retrieved, ICSI insemination cannot avoid TFF, and it may hamper the cumulative pregnancy rate.