One of the most common methods of IVF for infertile couples around the globe may be an expensive and invasive waste of time and may even reduce the chances of success, according to research published in The Lancet.

Professor Ben Mol, of Monash University in Australia, and Dr Rui Wang and colleagues in China, studied intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into a mature egg. It was originally developed in 1992 for couples with severe male infertility but which has since expanded in use in more than half of all embryo transfers. 

Over the past 30 years, use of ICSI has increased and now accounts for nearly two-thirds of IVF cycles worldwide, including 70% in Europe and North America and nearly 100% in some low-income and middle-income countries.

“The increased use of ICSI in couples with infertility without severe male factor has boomed because of the belief that use of ICSI might increase fertilization success, and now we have shown that this is incorrect,” said Professor Mol. 

In addition, there are health concerns about ICSI – which is an invasive procedure that bypasses natural selection barriers during the fertilization process. A recent Australian study indicated a small increased risk for genitourinary abnormalities after artificial reproduction, particularly after ICSI.

“Because a single sperm is isolated and injected into the egg, the natural selection process where a sperm cell beats millions of competitors is bypassed, which may lead concerns re potential risks to offspring health, including congenital anomalies,” Professor Mol said.

ICSI has been controversial in the fertility industry for years. Back in 2016, the editor-in-chief of the leading journal Human Reproduction, Professor Hans Evers, wrote: “The majority of the patients who will get pregnant with intracytoplasmic sperm injection (ICSI) will also do so with IVF.” 

Studies have shown that ICSI results in fewer live births than IVF when used for couples where male infertility is not the problem. “Intending to improve their patients’ pregnancy probability by preventing fertilization failure, well-meaning doctors actually decrease their chances. This has to stop. We have pledged to do no harm,” he writes.

Evers said doctors would 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.”