For us, the only option was ICSI due to severe male factor infertility on top of my severe PCOS. However, my FS said that in the absence of male factor problems, he'd still use ICSI as it gives much better results for women with PCOS. I wish I'd thought to question why...

I really don't believe it's bypassing natural selection, as the embryologists will be searching for the best-looking, best-moving sperm in the sample. They aren't just going to catch any old sperm, they will be looking for quality.

Also - ICSI doesn't guarantee fertilisation. I've had eggs injected that failed to actually fertilise. Don't know whether that's a sperm problem or an egg problem as it happened on cycles where I was hyperstimulated and egg quality was pretty poor. It also happened on the non-hyperstimulated cycle, which is why we went from 12 mature eggs to only 3 that fertilised, even using ICSI.

BW