Jain Tarun, Gupta Ruchi S
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA.
N Engl J Med. 2007 Jul 19;357(3):251-7. doi: 10.1056/NEJMsa070707.
Intracytoplasmic sperm injection (ICSI) was initially developed as part of in vitro fertilization (IVF) to treat male-factor infertility. However, despite the added cost, uncertain efficacy, and potential risks of ICSI, its use has been extended to include some patients without documented male-factor infertility.
We analyzed national data on assisted reproductive technology reported to the Centers for Disease Control and Prevention, to determine temporal trends in the use of ICSI and IVF in the United States, and we examined differences in the use of ICSI between states with and those without mandated insurance coverage.
From 1995 to 2004, the number of fertility clinics and fresh-embryo cycles and the rates of IVF-related pregnancies and live births increased. The percentage of IVF cycles with the use of ICSI also increased dramatically (from 11.0% to 57.5%), while the percentage of diagnoses of infertility attributed to male-factor conditions remained stable. The ratio of ICSI procedures to diagnoses of male-factor infertility steadily increased each year, suggesting an increasing use of ICSI for conditions other than male-factor infertility. From 1999 to 2004, there was an increasing use of ICSI relative to the percentage of patients with male-factor infertility in states with and those without mandated insurance coverage. For any given year, however, states with insurance coverage had a higher ratio of ICSI use to diagnoses of male-factor infertility than did states without insurance coverage (P<0.001).
Since 1995, the use of ICSI in the United States has increased dramatically, while the proportion of patients receiving treatment for male-factor infertility has remained stable. State-mandated health insurance coverage for IVF services is associated with greater use of ICSI for infertility that is not attributed to male-factor conditions.
胞浆内单精子注射（ICSI）最初是作为体外受精（IVF）的一部分开发出来，用于治疗男性因素导致的不孕症。然而，尽管ICSI成本增加、疗效不确定且存在潜在风险，但其应用范围已扩大到包括一些无男性因素不孕症记录的患者。
我们分析了向疾病控制与预防中心报告的辅助生殖技术的全国数据，以确定美国ICSI和IVF使用的时间趋势，并研究了有强制保险覆盖州和无强制保险覆盖州在ICSI使用上的差异。
1995年至2004年，生育诊所数量、新鲜胚胎周期数以及与IVF相关的妊娠率和活产率均有所增加。使用ICSI的IVF周期百分比也大幅上升（从11.0%升至57.5%），而归因于男性因素的不孕症诊断百分比保持稳定。ICSI操作与男性因素不孕症诊断的比例逐年稳步上升，这表明ICSI在男性因素不孕症以外的情况中的使用越来越多。1999年至2004年，在有和没有强制保险覆盖的州，相对于男性因素不孕症患者的百分比，ICSI的使用都在增加。然而，在任何给定年份，有保险覆盖的州ICSI使用与男性因素不孕症诊断的比例高于无保险覆盖的州（P<0.001）。
自1995年以来，美国ICSI的使用大幅增加，而接受男性因素不孕症治疗的患者比例保持稳定。州强制规定的IVF服务医疗保险覆盖与将ICSI更多地用于非男性因素导致的不孕症有关。
