# Trends in the Use and Indications for Intracytoplasmic Sperm Injection Between 2005 and 2017: A State‐Wide Descriptive Cohort Analysis

## TL;DR

This study examines how intracytoplasmic sperm injection (ICSI) was used in Victoria, Australia, from 2005 to 2017, finding a significant increase in its use beyond cases where it was medically necessary.

## Contribution

The study provides new insights into the growing use of ICSI for non-essential indications in an Australian context.

## Key findings

- ICSI use increased from 60.6% in 2005 to 79.5% in 2017.
- Most ICSI cycles after 2008 were classified as 'unspecified' and not medically indicated.
- Indications like donor sperm and pre-implantation genetic testing increased over time.

## Abstract

Intracytoplasmic sperm injection (ICSI) was first developed to overcome male factor infertility. ICSI has increased in uptake globally, including in cases where its use is non‐essential for fertilisation.

To identify temporal trends in the use of, and indications for ICSI in an Australian context.

A statewide descriptive cohort study examining the trends in ICSI uptake and reported indication/s for ICSI use. The cohort included women undergoing IVF between 2005 and 2017 at IVF clinics across Victoria, Australia that resulted in a birth after 20 weeks' gestation.

The dataset comprised 32 102 assisted reproduction cycles: 22 873 (71.3%) ICSI and 9229 (28.7%) conventional IVF. In 2005, ICSI accounted for 60.6% (1182/1952) of cycles, increasing to 79.5% (2344/2947) by 2017 (p
trend < 0.001). Testicular sperm retrieval as an indication for ICSI remained consistent over time (p
trend = 0.15). Male factor infertility as an indication decreased over time (p
trend = 0.007). Vitrified oocyte thaw (p
trend = 0.016) and ‘unexplained subfertility’ (p
trend = 0.30) cycles did not surpass 1.7% (39/2293) and 0.4% (9/2048), respectively of total cycles in any year. Donor sperm (p
trend = 0.001), pre‐implantation genetic testing (p
trend = 0.004), female factors associated with poor IVF outcome (p
trend = 0.005) and advanced maternal age (p
trend = 0.005) all increased as indications for ICSI over time. ‘Unspecified’ indication accounted for the majority of ICSI cycles after 2008 (p
trend = 0.015).

During our study period, the total use of ICSI increased by 18.9%. Notably, most of these cycles were not medically indicated.