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To the Editor Dr Boulet and colleagues1 reported rapid increases in national use of intracytoplasmic sperm injection (ICSI) over the last 2 decades, especially among in vitro fertilization (IVF) cycles without male factor infertility.
Their analysis relied on diagnoses of male factor infertility reported by IVF centers and not specific semen analysis parameters, which the US Centers for Disease Control and Prevention (CDC) does not track. However, the definition of abnormal semen parameters and therefore the primary indication for ICSI changed during the study period. The World Health Organization criteria were revised in 1999 and again in 2010,2 resulting in increasingly strict criteria and fewer abnormal semen analyses.
Kushnir VA, Barad DH, Gleicher N. Intracytoplasmic Sperm Injection and Reproductive Outcomes. JAMA. 2015;313(16):1672. doi:10.1001/jama.2015.3115