In order to maximize In vitro fertilization (IVF) success rates in advanced- age patients, it has been suggested to favor the use of intracytoplasmic sperm injection (ICSI) over conventional insemination (CI), with the notion that ICSI would serve as a tool to overcome interference in sperm oocyte interaction and sperm oocyte penetration issues that can be related to maternal age and are not due to sperm abnormalities. We therefore aim to evaluate the role of ICSI in the treatment of non-male factor infertile patients aged ≥35 in terms of fertilization and top-quality embryo rates. In this retrospective cohort study, data were collected and analyzed for all patients with non-male factor infertility, aged ≥35 treated, undergoing their first IVF cycle attempt with 6 or more oocytes yield, in whom a 50% ICSI-CI division was performed. Five hundreds and four oocytes were collected from 52 eligible patients. Overall, 245 oocytes underwent ICSI and 259 oocytes underwent CI. The fertilization rate was 71.0% following ICSI, compared to 50.1% in the CI treated oocytes (P < 0.001). The top quality embryo rate was 62.8% following ICSI compared to 45.5% following CI (P < 0.001). Subdividing the study population to two age groups revealed that the above differences remained significant in patients aged 35–39 yrs., whereas in those aged 40–45 yrs., the differences were non-significant but still inclined in favor of ICSI. This study favors the use of ICSI in the older IVF population in order to increase both the fertilization rate and the number of top quality embryos that result per IVF cycle. Further studies are needed to establish our observations and use ICSI as the preferred approach to overcome egg sperm abnormal interactions related to advanced maternal age.

Objective. To examine leading follicle size on human chorionic gonadotropin (hCG) day and pregnancy rate in anovulatory polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Design. Retrospective cohort study. Setting. Fertility clinics in women's health centers. Patients. Data on 291 infertile women with PCOS and irregular cycles who underwent 685 CC treatment cycles were used. Only cycles with one or two follicles >14 mm were included. hCG was administered once the leading follicle reached the size of 17–24 mm. Main outcome measure(s). Pregnancy rates in relation to leading follicle size. Results. Mono/bi-follicular response was observed in 418 cycles. Pregnancy rates were highest (13.6–18.6%) when hCG was administered in the presence of an 18–22 mm follicle, lowest with 17 mm, 23 mm and 24 mm (8.8%, 8.8% and 5.7%, respectively). No differences were observed in pregnancy rates between mono and bi-follicular cycles. Conclusions. In CC treatment, hCG should be administered when follicular size is at the range of 18–22 mm.