Massaro Peter A, MacLellan Dawn Lee, Anderson Peter A, Romao Rodrigo L P
Division of Urology, Izaak Walton Killam Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Urology, Izaak Walton Killam Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
J Urol. 2015 May;193(5 Suppl):1837-42. doi: 10.1016/j.juro.2014.10.113. Epub 2015 Mar 24.
We systematically reviewed and performed a meta-analysis of the genitourinary congenital malformation rate after conception by intracytoplasmic sperm injection compared to in vitro fertilization.
We systematically reviewed studies to compare perinatal outcomes between children conceived by intracytoplasmic sperm injection vs in vitro fertilization. Studies showing genitourinary congenital malformation rates were included. We assessed the risk of bias, focusing on the quality of genitourinary congenital malformation reporting and analysis targeted at singletons. Meta-analysis was done using a random effects model for 3 outcomes, including overall genitourinary congenital malformation, hypospadias and cryptorchidism. Sensitivity analysis was also performed in only studies at low risk for bias.
The initial search yielded 1,482 articles. We performed a full text review of 111 of these studies, of which 22 met inclusion criteria for systematic review. Meta-analysis of intracytoplasmic sperm injection and in vitro fertilization in 12,270 and 24,240 cases, respectively, revealed that intracytoplasmic sperm injection was associated with a significantly higher rate of overall genitourinary congenital malformation compared to in vitro fertilization (OR 1.27, 95% CI 1.02-1.59, p = 0.04). However, when including only 4 studies at low risk for bias with a total of 7,727 and 14,308 intracytoplasmic sperm injection and in vitro fertilization cases, respectively, the difference was not significant (OR 1.28, 95% CI 1.00-1.64, p = 0.05). There was no statistically significant difference in the rate of hypospadias (OR 1.21, 95% CI 0.87-1.69) or cryptorchidism (OR 1.39, 95% CI 0.97-2.00) between males conceived by intracytoplasmic sperm injection vs in vitro fertilization. On all analyses there was no significant statistical heterogeneity between studies (I(2) = 0).
Intracytoplasmic sperm injection is associated with a slightly higher risk of genitourinary malformation in offspring than in vitro fertilization. However, when only higher quality studies were analyzed, the difference was not significant. The hypospadias and cryptorchidism rates in offspring are similar for the 2 conception methods.
我们系统回顾并对卵胞浆内单精子注射受孕后与体外受精相比的泌尿生殖系统先天性畸形率进行了荟萃分析。
我们系统回顾了比较卵胞浆内单精子注射受孕与体外受精受孕儿童围产期结局的研究。纳入显示泌尿生殖系统先天性畸形率的研究。我们评估了偏倚风险，重点关注泌尿生殖系统先天性畸形报告的质量以及针对单胎的分析。对包括总体泌尿生殖系统先天性畸形、尿道下裂和隐睾症在内的3项结局采用随机效应模型进行荟萃分析。仅在偏倚风险较低的研究中进行敏感性分析。
初步检索得到1482篇文章。我们对其中111项研究进行了全文回顾，其中22项符合系统评价的纳入标准。分别对12270例和24240例卵胞浆内单精子注射和体外受精病例进行荟萃分析，结果显示与体外受精相比，卵胞浆内单精子注射受孕后总体泌尿生殖系统先天性畸形率显著更高（比值比1.27，95%置信区间1.02 - 1.59，p = 0.04）。然而，仅纳入4项偏倚风险较低的研究（分别有7727例和14308例卵胞浆内单精子注射和体外受精病例）时，差异无统计学意义（比值比1.28，95%置信区间1.00 - 1.64，p = 0.05）。卵胞浆内单精子注射受孕与体外受精受孕的男性之间，尿道下裂率（比值比1.21，95%置信区间0.87 - 1.69）或隐睾症率（比值比1.39，95%置信区间0.97 - 2.00）无统计学显著差异。所有分析中，各研究之间均无显著的统计学异质性（I² = 0）。
卵胞浆内单精子注射受孕后子代发生泌尿生殖系统畸形的风险略高于体外受精。然而，仅分析质量较高的研究时，差异无统计学意义。两种受孕方式的子代尿道下裂和隐睾症发生率相似。
