Is intracytoplasmic sperm injection (ICSI) the solution when there is not any problem; exploring ICSI vs in vitro fertilization (IVF) outcomes in sibling oocytes from donor sperm assisted reproductive technology (ART) cycles

CONTEXT: Intracytoplasmic sperm injection (ICSI) is increasingly used in assisted reproductive technology (ART), even in cases without male factor infertility. Its true benefit in such scenarios remains uncertain. AIMS: To determine whether ICSI provides any embryological or clinical advantage over conventional in vitro fertilization (IVF) in cycles without male factor infertility, using donor sperm and sibling oocytes. METHODS: This retrospective cohort study included 52 women treated at Lis Maternity and Women's Hospital (2018-2024). Each patient underwent split-cycle fertilization with both ICSI and IVF using donor sperm, with sibling oocytes serving as internal controls. Embryological outcomes (fertilization, morphology, Gardner grading, morphokinetics) and clinical outcomes (fresh and frozen embryo transfers, cumulative pregnancy rates) were compared. Cycles in which embryos from both methods were transferred were excluded. KEY RESULTS: ICSI achieved a higher fertilization rate than did IVF (87.5%, 45.05%); however, no significant differences were observed in embryo quality on the basis of morphology and Gardner criteria. Morphokinetic analysis showed higher Day 3 cleavage grading in ICSI embryos (79.80% vs 71.43% IVF), but these advantages did not translate into improved pregnancy outcomes, such as clinical pregnancy rates (33.33% ICSI, 18.6% IVF). CONCLUSION: Among women without known infertility factors undergoing ART with donor sperm, ICSI did not confer clinical advantages over conventional IVF, despite higher fertilization rates. IMPLICATIONS: Given the higher cost, invasiveness, and frequent overuse of ICSI, its application should be reserved for cases with clear indications.