Purpose: To determine if intracytoplasmic sperm injection (ICSI) offers an advantage over conventional oocyte insemination for women undergoing in vitro fertilization (IVF) and embryo transfer for unexplained infertility. Methods: A retrospective seven-year review of outcome following IVF with conventional insemination vs ICSI for the category of unexplained infertility. The decision on which method of insemination to use was made by the couple after hearing pros and cons with the consulting physician. Results: There was no difference in failed fertilization rates. However, the live delivered pregnancy rates were significantly higher for the group using conventional oocyte fertilization methods. Conclusions: Because of increased embryologist time and therefore increased expense to the patient it makes more sense to first try conventional oocyte insemination over ICSI for unexplained infertility, especially since the former results in a significantly higher live delivery rate.