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Endometriosis an Indication for IVF with ICSI

A recent study sought to investigate if intracytoplasmic sperm injection (ICSI), increases IVF success in patients with endometriosis.

Researchers analyzed the fertility treatment cycles of 221 patients with a confirmed endometriosis diagnosis, compared to 150 patients with unexplained infertility. In the endometriosis group, 124 patients had standard insemination, and 97 patients had ICSI. The ICSI group had a higher percentage of day 5 transfers, a higher clinical pregnancy rate and a higher live birth rate than the insemination group.

According to researchers, the findings suggest that endometriosis might be an indication for ICSI, which diminishes oxidative stress when compared to insemination. With ICSI, the cumulus cells surrounding the egg are removed to determine the egg’s maturity as well as to better visualize the egg during the ICSI process. One sperm is injected directly into the egg.

With both IUI and IVF the egg is surrounded by sperm, and the large majority of sperm is not healthy, explains Dr. Gianpiero Palermo, Director of Assisted Fertilization and Andrology at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Cornell. “Sperm produce oxygen free radicals. In the case of endometriosis, there are different toxic peptides that are present in the endometrium of the patient and in the cumulus cell. For ICSI, you remove the cumulus cell so this toxicity could be limited and diminished.”

“Leaving the oocyte and the cumulus cell around, overnight, in vitro, could be deleterious to the developing embryo,: Palermo says. Removing the cell right away after retrieval, like you do for ICSI, appears to be advantageous in patients with endometriosis.


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