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Temporal Differences in Utilization of Intracytoplasmic Sperm Injection Among U.S. Regions

Zagadailov, Pavel MD; Hsu, Albert MD; Stern, Judy E. PhD; Seifer, David B. MD

doi: 10.1097/AOG.0000000000002730
Reproductive Endocrinology and Infertility: Original Research

OBJECTIVE: To analyze changes in intracytoplasmic sperm injection (ICSI) utilization, indications, and outcomes across U.S. regions.

METHODS: We conducted a retrospective cohort study. Data sets for 2000–2014 were obtained from the Centers for Disease Control and Prevention. Clinics with 100 or greater fresh, nondonor cycles were grouped by 10 nationally recognized Department of Health and Human Services (DHHS) regions and were compared for use of ICSI, frequency of male factor infertility, preimplantation genetic therapies, pregnancy, and live birth rates per cycle among fresh in vitro fertilization cycles in women younger than 35 years of age.

RESULTS: Nationwide ICSI utilization increased 52% (46.3±6.1% to 70.0±7.1%) from 2000 to 2014, whereas pregnancy and live birth rates per cycle modestly increased by 8.5% (39.2±3.8% to 42.5±2.5%) and 7.6% (34.4±3.6% to 37±2.6%), respectively, showing a positive correlation (r=0.78, P<.001; r=0.76, P=.001) with ICSI rates per clinic. All DHHS Services regions demonstrated increases in ICSI utilization over time, although the magnitude of increase varied in different regions. Regions also had similarities in trends for pregnancy and live birth rates per cycle in women younger than 35 years. There was no correlation between male factor and ICSI rates per clinic from 2000 to 2010 (r=0.32, P=.33) or 2011 to 2014 (r=0.85, P=.068). From 2007 to 2014, ICSI and preimplantation genetic testing did not demonstrate a strong correlation (r=0.68, P=.062).

CONCLUSION: From 2000 to 2014, ICSI rates per clinic significantly varied among geographic regions. Increased use of ICSI did not correlate with an increase in male factor diagnoses. These findings suggest that ICSI may be overused, because its use is not accompanied by proportionate increases in medical indications or effectiveness.

Intracytoplasmic sperm injection rates per cycle increased over time among U.S. regions without proportionate increases in medical indications or effectiveness.

Dartmouth-Hitchcock and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Yale University School of Medicine, New Haven, Connecticut; the University of Missouri School of Medicine, Columbia, Missouri; and Clinical Outcomes Research Group, CORG LLC, Grantham, New Hampshire.

Corresponding author: Pavel Zagadailov, MD, Clinical Outcomes Research Group, CORG LLC, 178 Meadow Brook Road, Grantham, NH 03753; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received January 19, 2018. Received in revised form April 3, 2018. Accepted April 12, 2018.

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.