Study question

Can ICSI be helpful in resolving paternal chromosomal abnormality in women with recurrent miscarriage and yielding a better clinical outcome?

Summary answer

In women with recurrent miscarriage with normal sperm, administration of ICSI for reducing paternal chromosomal abnormality did not have positive effect in the pregnancy and abortion rate.

What is known already

RM (recurrent miscarriage) is characterized by a heterogeneous population, and in more than 50% of the couples with RM, the cause of miscarriage remains unexplained. One of the RM risk factor is embryonal chromosomal abnormality. Due to the fact that ICSI can select sperm that shows a normal morphology, we supposed that it might possibly reduce paternal chromosomal abnormality. In our study, we aimed to determine whether ICSI can help women with recurrent miscarriage.

Study design, size, duration

All fresh, non-donor in vitro fertilization (IVF) cycles performed from January 2010 through December 2013 (n=223) were included in this study. A total of 141 patients underwent conventional IVF while 82 patients underwent IVF with ICSI.

Participants/materials, setting, methods

All patients had two or more spontaneous abortions, male factors were considered normal based on WHO standards. Outcome measures included method of fertilization, pregnancy rate, ongoing pregnancy rate and abortion rate.

Main results and the role of chance

Patient characteristics were similar in the two groups. In each group, age (IVF: 35.3±4.5; IVF with ICSI: 35.7±4.3 P=0.06), basal FSH (6.9±3.0; 6.2±3.2 mIU/ml P=0.18), duration of rFSH (10.0±2.2; 9.3±2.0 P=0.18), and endometrial thickness (10.3±1.3; 9.9±2.0 P=0.58) did not show significant differences. There were no significant differences between two groups in the number of MII oocytes (11.8±8.0; 10.6±7.3 P=0.51), fertilization rate (92.3±13.3; 88.6±16.5 p=0.07), pregnancy rate (47.5%; 47.6% P=0.93), ongoing pregnancy rate (41.8%; 41.5% P=0.90) and abortion rate(11.9%; 12.8% P=0.90).

Limitations, reasons for caution

In our study, we were not able to select only unexplained RM patients. We believed ICSI can be helpful, although not complete, just like the pre-implantation genetic diagnosis (PGD) method. However ICSI was not able to decrease abortion rate.

Wider implications of the findings

ICSI fertilization method was carried out on women with recurrent miscarriage in order to reducing paternal chromosomal abnormality. However, the results showed that there was no positive effect in both pregnancy rate and abortion rate. It seems that the ICSI would not be necessary for such patients. Our study shows chromosomally abnormal sperm cannot be detected by ICSI alone and various causes can lead to unexplained recurrent miscarriage.