van Rumste M M E, Evers J L H, Farquhar C M
Department of Obstetrics and Gynaecology, Academic Hospital Maastricht, P. Debyelaan 25, Postbus 5800, 6202 AZ Maastricht, The Netherlands.
Hum Reprod. 2004 Feb;19(2):223-7. doi: 10.1093/humrep/deh061.
This paper is based on a Cochrane review of the same title by the same authors published in The Cochrane Library, issue 3, 2003 (see www.CochraneLibrary.net for information) with permission from the Cochrane Collaboration-John Wiley and Sons. Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the review.
The objective of this review was to investigate whether ICSI improves live-birth rate in comparison with IVF in couples with non-male factor subfertility.
We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched 30 May 2002), the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2002), PubMed (January 1992 to September 2003) and reference lists of articles. Trials were included if they compared the effects of ICSI and IVF on live births, pregnancy and fertilization outcomes. Only randomized studies were included in this review. Two reviewers extracted data independently.
There were no randomized data comparing live-birth rates. The single identified study did not find a difference in pregnancy rates (OR 1.4, 95% CI 0.95-2.2). There were no randomized data on miscarriage rates, or on other adverse events such as congenital malformations that may be of concern (415 couples randomized). Two studies used alternation to assign their couples and did have live birth as an outcome. These studies showed a significantly higher fertilization rate in the IVF group, but no difference in pregnancy, miscarriage or live-birth rate.
Whether ICSI should be preferred to IVF for cases of non-male factor subfertility remains an open question. Further research should focus on live-birth rates and adverse events.
本文基于同一作者发表在《Cochrane图书馆》2003年第3期的同标题Cochrane综述（有关信息见www.CochraneLibrary.net），经Cochrane协作网 - 约翰威立父子出版公司许可。随着新证据的出现以及对评论和批评的回应，Cochrane综述会定期更新，如需该综述的最新版本，应查阅《Cochrane图书馆》。
本综述的目的是调查在非男性因素导致的不育夫妇中，与体外受精（IVF）相比，卵胞浆内单精子注射（ICSI）是否能提高活产率。
我们检索了Cochrane月经失调与不育症研究组试验注册库（检索日期为2002年5月30日）、Cochrane对照试验注册库（《Cochrane图书馆》2002年第2期）、PubMed（1992年1月至2003年9月）以及文章的参考文献列表。如果试验比较了ICSI和IVF对活产、妊娠和受精结局的影响，则纳入该试验。本综述仅纳入随机研究。两名综述作者独立提取数据。
没有比较活产率的随机数据。唯一一项已识别的研究未发现妊娠率有差异（比值比1.4，95%可信区间0.95 - 2.2）。没有关于流产率或其他可能令人关注的不良事件（如先天性畸形）的随机数据（415对夫妇被随机分组）。两项研究采用交替法对夫妇进行分组，且将活产作为一项结局指标。这些研究显示IVF组的受精率显著更高，但在妊娠、流产或活产率方面没有差异。
对于非男性因素导致的不育病例，ICSI是否应优先于IVF仍未确定。进一步的研究应聚焦于活产率和不良事件。
