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Is Intracytoplasmic Sperm Injection the Solution for all in Unexplained Infertility?

Semin Reprod Med 2020; 38(01): 036-047 – 2021-01-14

Danni Zheng 1-7, Quynh N. Nguyen 7, Rong Li  1-6, Vinh Q. Dang 7,8

Published: 05 November, 2020

1  Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
2  National Clinical Research Center for Obstetrics and Gynecology, Beijing, China
3  Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China
4  Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
5  Beijing Advanced Innovation Center for Genomics, Beijing, China
6  Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
7  IVFMD, My Duc Hospital, Ho Chi Minh, Vietnam
8  HOPE Research Center, My Duc Hospital, Ho Chi Minh, Vietnam


Intracytoplasmic sperm injection (ICSI) was first introduced as a supplemental method to conventional in vitro fertilization (c-IVF) for couples with severe male factor infertility to overcome the poor fertilization rate, while its indications expanded in current clinical practice and gained worldwide popularity. However, ICSI is invasive and crosses all natural barriers, raising several unresolved concerns regarding procedure-dependent and procedure-independent risks, as well as the characteristic of being labor-intensive and more expensive than c-IVF. This review is aimed to draw readers’ attention, to the widespread use of ICSI worldwide, with its effectiveness in different indications of infertility, especially in those with unexplained infertility, as well as the cost-effectiveness of the ICSI-for-all strategy. Also, we covered current evidence on the short- and long-term safety of children born thanks to ICSI-aided conception. Further well-designed, adequately powered, and randomized controlled clinical trials are absolutely needed to arrive at a consensus on the use of ICSI over c-IVF in different populations.


intracytoplasmic sperm injection – unexplained infertility – assisted reproductive technology – conventional in vitro fertilization – infertility