Editing Infertility: Management (section)

====In-vitro Fertilization (IVF) with/out ICSI====
*'''<span style="color:#ff0000">In IVF, the egg and sperm (of which there are multiple) are left in a petri dish to fertilize on their own. In ICSI, one sperm is directly injected into the egg.'''
*'''ICSI minimizes any adverse effects of sperm “quality” as measured by sperm concentration, motility, and morphology as long as viable sperm are present to inject into all oocytes'''
**With IVF, abnormal sperm motility and morphology adversely affect fertilization rates. The application of ICSI during IVF treatment provided fertilization rates comparable to that observed with otherwise normal sperm
*Requires only a small number of motile sperm, compared to IUI[https://pubmed.ncbi.nlm.nih.gov/33295257/ §]
*Involves limited medical risk to the female partner
*IVF treatment requires more than a week of ovarian stimulation, procedures for oocyte retrieval and intrauterine embryo transfer
*Couple may need to undergo several cycles of IVF treatment in order to achieve a pregnancy
**Each attempt typically allows for a 33% live delivery rate per initiated IVF cycle
***Pregnancy and live birth results are closely related to female age, with progressively lower success with increased female age (>35 years)
***≈19% of all deliveries involve twins
*'''In men undergoing surgical sperm retrieval, either fresh or cryopreserved sperm may be used for ICSI[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
**A meta-analysis evaluating the use of sperm from men with NOA found no significant differences in fertilization, pregnancy, or live birth rates from ICSI in men for whom sperm was extracted and used with or without cryopreservation, as long as there were sperm of adequate number and survived cryopreservation and thawing.[https://pubmed.ncbi.nlm.nih.gov/29785532/]