The Timing of Intracytoplasmic Sperm Injection Relative to Oocyte Retrieval: A Systematic Review and Meta-Analysis

Isha Gupta, Mathilda Thorrowgood, Kevin John Ashton, Evelyne Rathbone, Vincent Chapple, Yanhe Liu

Research output: Contribution to journalLiterature reviewResearchpeer-review

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It is currently inconclusive whether different intracytoplasmic sperm injection (ICSI) timings post oocyte retrieval (POR) lead to altered chance of clinical pregnancy and live birth following in vitro fertilization (IVF) treatment. This study, therefore, aimed to synthesize literature-based evidence for better clinical guidance regarding ICSI practice.

A systematic review and meta-analysis were performed according to PRISMA guidelines. Studies were searched for in PubMed, MEDLINE, EMBASE, and the Cochrane Library. Outcome endpoints included clinical pregnancy and live birth rates (LBRs).

A total of 605 records were retrieved in the initial search. After exclusion, 30 articles were included for further screening for eligibility. For meta-analysis, 1 prospective and 5 retrospective cohort studies were included for pooled analysis, from which clinical pregnancy rates (CPRs) were evaluated in 6 studies while LBRs were evaluated in 3 studies. CPRs were comparable when ICSI was performed at (a) <2 hours POR (risk ratio or RR = 1.00, 95% confidence interval [CI] 0.94–1.08) vs 2+ hours, (b) <3 hours (RR = 1.01, 95% CI 0.88–1.16) vs 3+
hours, (c) <4 hours (RR = 0.99, 95% CI 0.93–1.05) vs 4+ hours, (d) <5 hours (RR = 0.98, 95% CI 0.93–1.02) vs 5+ hours, and (e) <6 hours (RR = 1.05, 95% CI 0.90–1.23) vs 6+ hours. However, LBR was reduced when ICSI was performed <5
hours POR vs 5+ hours (RR = 0.94, 95% CI 0.89–0.99), but such reduction disappeared when comparing <6 hours POR (RR = 1.09, 95% CI 0.85–1.38) vs 6+ hours.

CPRs remain comparable when ICSI is performed at a range of timings up to 6-hour POR. However, LBR may benefit slightly by scheduling ICSI between 5- and 6-hour POR.
Original languageEnglish
Pages (from-to)8-14
Number of pages7
JournalFertility & Reproduction
Issue number1
Publication statusPublished - 30 Nov 2022


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