Clinics Might Be Overusing Sperm Injection Method In Fertility Treatments
Fertility clinics might be overusing a laboratory technique calledintracytoplasmic sperm injection despite the technique's additionalcost, uncertain efficacy and risks, according to a study publishedThursday in the New England Journal of Medicine, the AP/Seattle Post-Intelligencer reports (Stobbe, AP/Seattle Post-Intelligencer, 7/18).
ICSIis a process in which a single sperm is placed into an egg using asyringe, and it is used when a man has a low semen count or poor spermquality (Kaiser Daily Women's Health Policy Report,7/3). The technique adds about $1,500 to the $12,400 average cost of anin vitro fertilization treatment cycle, the study's authors said (AP/Seattle Post-Intelligencer, 7/18).
For the study, Tarun Jain, assistant professor of reproductive endocrinology and infertility at the University of Illinois-Chicago,and colleagues examined data from 1995 to 2004 on fertility treatmentsat U.S. clinics. The study looked at all IVF cycles involving newembryos from nondonor eggs in women younger than age 43, HealthDay/Forbes reports.
According to the study, the percentage of IVF treatment cycles that used ICSI increased from 11% in 1995 to 57.5% in 2004 (HealthDay/Forbes,7/18). Researchers also found that the proportion of couples who haddifficulty conceiving because the man's sperm remained at 34%throughout the study period. The study also showed that among IVFattempts with successful egg retrievals in 2004, about 31% that usedICSI resulted in a live birth, compared with 33% for those that did notuse the technique.
The study showed a higher risk of birthdefects among infants conceived through ICSI, but the researchers saidthey are unclear whether it is the result of the technique orabnormalities in the fathers' sperm (AP/Seattle Post-Intelligencer,7/18). In addition, researchers found that ICSI rates were higher instates where insurance coverage of the technique is mandated --including Illinois, Massachusetts and Rhode Island -- than in stateswithout mandated coverage.
"Despite its added cost and uncertain efficacy and risk, the use ofICSI has been extended to include patients without documentedmale-factor infertility," Jain said in a statement. He added thatfurther studies are "needed to better understand the proper role ofICSI," and that "guidelines may be useful to determine what the bestindications are for the use of the technology in patients withoutmale-factor infertility" (HealthDay/Forbes, 7/18). Jainnoted that he did not have specific data about each couple or eachtreatment attempt, making it difficult to determine whether clinicsthat frequently performed ICSI also had disproportionate numbers ofpatients with more severe cases.
Steve Ory, president of the American Society of Reproductive Medicine,said that there are several reasons a clinic might use ICSI to treat aninfertile couple, and that it is unclear whether the technique is beingoverused. According to the researchers and Ory, some clinics might useICSI in cases where there are only a few eggs available or in caseswhere traditional IVF failed. Some clinics might choose to use it forall couples, believing it can increase the chance of success, the AP/Post-Intelligencer reports. "There's a lot of art to this," Ory said. Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics,said, "This paper is particularly troubling because we've got a majorshift in practice that isn't evidence driven. The paper suggests it maybe driven by money" (AP/Seattle Post-Intelligencer, 7/18).
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