Impact of intracytoplasmic sperm injection in women with non-male factor infertility: A systematic review and meta-analysis.

When couples struggle to conceive, doctors often recommend assisted reproductive technologies like IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). While ICSI — where a single sperm is injected directly into an egg — was originally developed for male infertility issues, it has increasingly been used for women with no identified male factor infertility. But is it actually better?

A large research review published in Frontiers in Reproductive Health analyzed 26 studies, including 6 high-quality randomized controlled trials, to compare ICSI and standard IVF outcomes in women where male infertility was not the problem.

The results were clear: ICSI offered no meaningful advantage over conventional IVF for these women. Fertilization rates, pregnancy rates, live birth rates, and miscarriage rates were statistically similar between the two procedures. Interestingly, standard IVF actually showed a better embryo implantation rate than ICSI. For women aged 35 and older using fresh embryo transfers, IVF also produced higher live birth rates.

This matters because ICSI is a more invasive and typically more expensive procedure than conventional IVF. Using it without a clear clinical reason may not improve outcomes — and could potentially be unnecessary.

So where does acupuncture fit in? Many women undergoing fertility treatments turn to acupuncture as a complementary support. Research has explored acupuncture's potential to reduce stress, support hormonal balance, and improve uterine blood flow — all factors that may play a role in IVF success. While acupuncture is not a replacement for medical fertility treatment, it is often used alongside it to support overall well-being during what can be an emotionally and physically demanding process.

If you are navigating fertility treatment decisions, speak with a licensed acupuncturist who specializes in reproductive health to explore how integrative care might support your journey.

This systematic review and meta-analysis (26 studies; 6 RCTs, 20 retrospective cohort studies; data through May 2022) evaluated ICSI versus conventional IVF in women with non-male factor infertility. Primary endpoints included laboratory and pregnancy outcomes; secondary endpoints covered neonatal outcomes. Results showed no statistically significant differences between ICSI and IVF in fertilization rate (RR=0.99), total fertilization failure (RR=1.30, though trending higher with ICSI), good-quality embryo rate (RR=0.94), clinical pregnancy rate (RR=0.84), live birth rate (RR=0.89), miscarriage rate (RR=1.06), preterm delivery (RR=0.92), or low birth weight (RR=1.13). Notably, IVF demonstrated superior implantation rates (RR=0.77, 95% CI [0.64–0.93], P=0.005). Subgroup analysis indicated IVF yielded higher live birth rates in women ≥35 using fresh embryo transfers (RR=0.82, P<0.001). Clinical takeaway: ICSI confers no benefit over IVF in non-male factor infertility; practitioners supporting patients through ART cycles should note that IVF remains the evidence-preferred protocol in this population.