This 3D rendering shows the intra-cytoplasmic sperm injection process, in which a single sperm is injected directly into an egg. Image / Getty Images
This 3D rendering shows the intra-cytoplasmic sperm injection process, in which a single sperm is injected directly into an egg. Image / Getty Images
Desperate New Zealand couples could be forking out an extra $2000 for an in vitro fertilisation (IVF) "add-on" procedure which may worsen their chance of having children, according to a new study.
The Australian and New Zealand Journal of Obstetrics and Gynaecology reported the findings of researchers from a MelbourneIVF clinic, which looked at historical data collected between 2009 and 2015.
The findings, reported in The Conversation last week, found that for every 15 couples who have the intra-cytoplasmic sperm injection (ICSI) add-on procedure, but who do not have diagnosed male infertility — for which the procedure can make a difference — one less pregnancy was achieved when compared to couples who used standard IVF only.
But experts at two New Zealand clinics spoken to by the Weekend Herald said ICSI was being used responsibly here. One said they had the same success rate for IVF and ICSI at their clinic.
According to The Conversation, the Melbourne researchers reviewed more than 3500 cycles of fertility treatment, looking at couples who had exclusively female infertility, or unexplained fertility, and excluded couples who had male infertility.
They did this because they wanted to understand if ICSI could help couples beyond those with male-factor infertility, such as poor quality sperm or a low sperm count, for whom ICSI was developed because it removed an existing barrier of fertilisation.
ICSI is when a single sperm is injected into an egg to make fertilisation occur, something which would normally happen in the woman's fallopian tube or, in the case of IVF, in a dish.
But the researchers found ICSI could actually hinder the chance of success for couples without male infertility, which concerned them as data collected from New Zealand and Australia showed almost 65 per cent of couples were having ICSI as part of their fertility treatment, but male infertility levels in couples with fertility issues was only about 40 to 50 per cent, The Conversation reported.
"This is concerning because prospective parents using IVF are often vulnerable, and willing to pay thousands of dollars for any procedure they believe might improve their chance of conceiving. We need to ensure whatever they're being offered is grounded in the strongest scientific evidence."
They had previously noticed an increase in people being offered ICSI, and taken a closer look, Repromed Fertility scientific director Debbie Blake told the Weekend Herald.
"We saw it starting to creep up ... and we had to see why."
Debbie Blake, pictured with her baby son Sam in 2003, is the scientific director at Repromed Fertility. Photo / Kenny Rodger
There was almost no reason to use ICSI in the case of female infertility, but when the cause was undiagnosed clinicians may have started using it in case there was an undiagnosed problem with fertilisation.
"It's usually for people with years of undiagnosed fertility [issues] ... it can start getting used exclusively, in particular if there's a doubt [about fertilisation chances].
"This paper shows if you use it willy-nilly for everybody who doesn't need it you are going to get reduced success rates."
That was because ICSI involved more intervention than IVF, Blake said.
"Each step has extra risks for the egg. It's fantastic for people who really need it, but if you don't need it, why would you?"
The report showed ICSI rates for all New Zealand and Australia clinics was 65 per cent, "but I know in New Zealand, particularly the clinics in Auckland, it's about 50/50. It's 50 per cent in our clinic, but over the years it's been much higher than that, it can be up to 70 per cent", she said.
Each step has extra risks for the egg. It's fantastic for people who really need it, but if you don't need it, why would you?
"We're happy to see these kind of studies. It kind of verifies what we thought — more intervention's going to get less desirable outcomes."
However, the Melbourne study had a flaw in that it was retrospective, so it was not possible to know if the couples involved had treatment at other clinics before data relating to their treatment was used.
"In a controlled study you would know that."
An IVF cycle cost $8640, with another $3500 to $5500 on top for medication. Adding ICSI was another $2195 for a cycle, Blake said.
They would sometimes split treatment between ICSI and IVF when appropriate.
She didn't think people were being offered ICSI as part of a "money-making" scheme. "I think it's more about using the right techniques for the right people and not being scared to get a poor result ... everybody does want a happy ending."
Dr Mary Birdsall is a reproductive specialist at Fertility Associates. Photo / Supplied
Fertility Associates reproductive specialist Mary Birdsall said they used ICSI for male infertility or in situations with previous failed fertilisation. ICSI was used in about 60 per cent of their IVF cycles.
They hadn't seen the negative effect on success rates reported by the Australian study. "We see the same success rate results whether IVF or ICSI."
An ICSI cycle at Fertility Associates cost $2000 on top of IVF, which cost between $11,000 and $13,000 per cycle, depending on drug usage.
She was aware some overseas clinics, particularly in Asia, used ICSI in all cases.
"I think there's a definite trend with that [unnecessary ICSI] in some other units offshore. But I think in New Zealand we've resisted that trend."
