| Summary: | The aim of the study was to assess the fertilization rate (FR) of randomized sibling oocytes inseminated by conventional IVF or ICSI in couples with unexplained infertility. Methods The 16-month study was conducted at an established private IVF facility. Oocytes recovered from couples with normal semen parameters and normal DNA fragmentation index (DFI; <30%), were randomly allocated to IVF or ICSI and the FR (2PN/MII) was assessed. Pregnancy outcome following embryo transfers were analyzed with regards to either IVF-embryo vs. ICSI-embryo, and in relation to DFI levels. Results Of 585 oocytes retrieved from 38 patients, 463 were mature (MII). The ICSI group generated a significantly higher number of 2PN embryos with a mean FR of 83.4% vs. 67.6% (p<0.05). There were no cases of complete fertilization failure (CFF) in the ICSI group, but there were 7.9% in the IVF group. The significant difference of FR was observed only when the DFI level was ≥ 15% and if such cutoff was applied, the CFF cases would be reduced to 2.6%. Of the 30 patients who had fresh embryo transfers performed, the ICSI group showed a higher pregnancy rate (69.2% vs. 58.8%; N.S.) with a significantly higher mean DFI value in the non-pregnant group (p<0.05). Conclusions IVF-ICSI split insemination can reveal those cases which will benefit from ICSI even where semen parameters and DFI are normal; however if the DFI is reduced to a 15% cut-off level, the rate of CFF will be minimized, but not completely excluded, even at 5%..
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