Instituto Bernabeu

A low ovarian response is an increasingly common situation for clinicians. It is mainly associated with delayed motherhood and, accordingly, with lower ovarian reserves. In this type of patients, the number of oocytes retrieved after puncture is normally limited. In this situation, choosing the most adequate fertilisation technique, conventional IVF or Intracytoplasmic Sperm Injection (ICSI), may stir a little controversy (of course, provided that the sperm quality and the medical history lead us to consider conventional IVF as a reasonable option).

One could speculate about the possibility that ICSI improved the results in this group of patients insofar as it might contribute to reducing the chances of low fertilisation rates or even of not any oocyte being fertilised by conventional IVF.

Nevertheless, analysis of the data readily shows that the reality is otherwise and there are certainly no differences between both techniques as far as the chances of a total fertilisation failure occurring in these patients are concerned. Furthermore, fertilisation rates remain practically the same regardless of the technique used, and a similar number of embryos are collected.

Finally, no differences are found either in the most relevant clinical parameters, such as positive β-HCG, clinical pregnancy and implantation rates.

Therefore, use of ICSI does not seem to have any positive effects on success rates when compared with conventional IVF in patients with a low oocyte count. For this reason, our opinion is that indiscriminate use of ICSI is not justified, especially in view of the unnecessary manipulation that gametes would have to experience.

Jaime Guerrero, biologist at Instituto Bernabeu.

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