ICSI use in US clinics far exceeds reported male factor infertility, national data show

IVF.net Newsdesk

03 October 2026

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ICSI use in US clinics far exceeds the rate of reported male factor infertility, a national clinic-level analysis finds. It was published open access in the Journal of Assisted Reproduction and Genetics on 29 September 2026. J Assist Reprod Genet

Desposorio and Stansbury examined data reported to the US Centers for Disease Control and Prevention (CDC) for 2021 and 2022, covering 751 clinic-years from 399 clinics. Median intracytoplasmic sperm injection (ICSI) use was 87.8% of cycles. Median reported male factor infertility was 27.7%. ICSI use exceeded the clinic's own male factor rate in 97.9% of clinic-years. Desposorio and Stansbury, 2026

Clinics with higher use of preimplantation genetic testing (PGT) tended to have a larger gap between their ICSI and male factor rates (Spearman rho 0.312, a modest positive correlation). The authors note that these ecological data cannot establish cause and describe the findings as hypothesis-generating. The two figures also use different denominators, so they show clinic patterns, not inappropriate use in individual cycles.

For laboratories, the reasons for routine ICSI are familiar: avoiding total fertilisation failure, and simplifying scheduling. Some labs also use it to keep cumulus cell and extraneous sperm DNA out of PGT samples, a concern the authors note has lessened for PGT-A with current protocols. A 2021 multicentre randomised trial of 1,064 couples, cited by the authors, did not show a live birth benefit for ICSI over conventional insemination in non-male factor cases. ICSI also adds operator time, cost and an invasive step. If your ICSI rate sits far above your male factor rate, can you name the indication for each case?

For more on embryo testing, see IVF.net's report on the latest PGT-A systematic review.