卵胞浆内单精子注射的使用趋势及相关生殖结局

Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection.

作者信息

Boulet Sheree L, Mehta Akanksha, Kissin Dmitry M, Warner Lee, Kawwass Jennifer F, Jamieson Denise J

机构信息

Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.

Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia2Department of Urology, Emory University School of Medicine, Atlanta, Georgia.

出版信息

JAMA. 2015 Jan 20;313(3):255-63. doi: 10.1001/jama.2014.17985.

DOI:10.1001/jama.2014.17985

PMID:25602996

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4343214/

Abstract

IMPORTANCE

Intracytoplasmic sperm injection (ICSI) is increasingly used in patients without severe male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF).

OBJECTIVE

To assess national trends and reproductive outcomes for fresh IVF cycles (embryos transferred without being frozen) following the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use.

DESIGN, SETTING, AND POPULATION: Retrospective cohort study using data on fresh IVF and ICSI cycles reported to the US National Assisted Reproductive Technology Surveillance System during 1996-2012.

MAIN OUTCOMES AND MEASURES

Trends in ICSI use during 1996-2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield, and 2 or more prior assisted reproductive technology cycles; reproductive outcomes for conventional IVF and ICSI cycles during 2008-2012, stratified by the presence or absence of male factor infertility.

RESULTS

Of the 1,395,634 fresh IVF cycles from 1996 through 2012, 908,767 (65.1%) used ICSI and 499,135 (35.8%) reported male factor infertility. Among cycles with male factor infertility, ICSI use increased from 76.3% (10,876/14,259) to 93.3% (32,191/34,506) (P < .001) during 1996-2012; for those without male factor infertility, ICSI use increased from 15.4% (4197/27,191) to 66.9% (42,321/63,250) (P < .001). During 2008-2012, male factor infertility was reported for 35.7% (176,911/494,907) of fresh cycles. Among those cycles, ICSI use was associated with a lower multiple birth rate compared with conventional IVF (30.9% vs 34.2%; adjusted relative risk [RR], 0.87; 95% CI, 0.83-0.91). Among cycles without male factor infertility (n = 317,996), ICSI use was associated with lower rates of implantation (23.0% vs 25.2%; adjusted RR, 0.93; 95% CI, 0.91-0.95), live birth (36.5% vs 39.2%; adjusted RR, 0.95; 95% CI, 0.93-0.97), and multiple live birth (30.1% vs 31.0%; adjusted RR, 0.93; 95% CI, 0.91-0.95) vs conventional IVF.

CONCLUSIONS AND RELEVANCE

Among fresh IVF cycles in the United States, ICSI use increased from 36.4% in 1996 to 76.2% in 2012, with the largest relative increase among cycles without male factor infertility. Compared with conventional IVF, ICSI use was not associated with improved postfertilization reproductive outcomes, irrespective of male factor infertility diagnosis.

摘要

重要性

胞浆内单精子注射（ICSI）越来越多地用于无严重男性因素不孕症的患者，但尚无明确证据表明其比传统体外受精（IVF）更具优势。

目的

评估与传统IVF相比，ICSI应用于新鲜IVF周期（未冷冻胚胎移植）的全国趋势及生殖结局，以了解ICSI的临床应用指征。

设计、设置和人群：一项回顾性队列研究，使用1996 - 2012年期间向美国国家辅助生殖技术监测系统报告的新鲜IVF和ICSI周期数据。

主要结局和指标

1996 - 2012年期间ICSI在男性因素不孕症、不明原因不孕症、38岁及以上产妇年龄、低卵母细胞产量以及2次或更多次既往辅助生殖技术周期方面的应用趋势；2008 - 2012年期间按有无男性因素不孕症分层的传统IVF和ICSI周期的生殖结局。

结果

在1996年至2012年的139563个新鲜IVF周期中，908767个（65.1%）使用了ICSI，499135个（35.8%）报告有男性因素不孕症。在有男性因素不孕症的周期中，1996 - 2012年期间ICSI的使用率从76.3%（10876/14259）增至93.3%（32191/34506）（P <.001）；在无男性因素不孕症的周期中，ICSI的使用率从15.4%（4197/27191）增至66.9%（42321/63250）（P <.001）。在2008 - 2012年期间，35.7%（176911/494907）的新鲜周期报告有男性因素不孕症。在这些周期中，与传统IVF相比，ICSI的应用与较低的多胎出生率相关（30.9%对34.2%；调整后相对风险[RR]，0.87；95%置信区间[CI]，0.83 - 0.91）。在无男性因素不孕症的周期（n = 317996）中，与传统IVF相比，ICSI的应用与较低的着床率（23.0%对25.2%；调整后RR，0.93；95%CI，0.91 - 0.95）、活产率（36.5%对39.2%；调整后RR，0.95；95%CI，0.93 - 0.97）和多胎活产率（30.1%对31.0%；调整后RR，0.93；95%CI，0.91 - 0.95）相关。