Subzonal insemination, partial zona dissection or intracytoplasmic sperm injection? An easy decision?

This review aims to analyse and compare the results to dateof subzonal insemination (SUZI), partial zona dissection (PZD)and intracytoplasmic sperm injection (ICSI) to evaluate criticallywhether it is now possible to replace SUZI and PZD by ICSI.It appears that ICSI is a much more efficient assisted reproductiontechnique than SUZI and PZD for resolving cases of severe maleinfertility and/or repeated failure of conventional in-vitrofertilization (IVF). For ICSI compared with SUZI and PZD, fertilization(49.4, 17.7 and 16.8% respectively), percentage of patientsreaching embryo transfer (91.0, 55.1 and 23.3% respectively),percentage of transfers performed with two or three embryos(83.3% ICSI and 39.3% SUZI), pregnancy rate per embryo replacement(28.2, 18.7 and 16.5% respectively) and pregnancy rate per oocyteretrieval (24.8, 10.3 and 3.8% respectively) are all improved.In addition, cases of severely impaired semen characteristics,which were condemned to infertility for life with conventionalIVF, SUZI or PZD, can now be treated and resolved efficientlywith ICSI.