Schwarze Juan-Enrique, Jeria Rodrigo, Crosby Javier, Villa Sonia, Ortega Carolina, Pommer Ricardo
Reproductive Medicine Unit, Clinica Monteblanco, Camino a Farellones 18780, Lo Barnechea, Santiago 7690000, Chile.
Obstetrics and Gynecology, Universidad de Santiago, Av Libertador Bernardo O'Higgins 3363, Santiago, Estación Central, Chile.
Hum Reprod Open. 2017 Aug 30;2017(2):hox013. doi: 10.1093/hropen/hox013. eCollection 2017.
Does the use of ICSI offer any outcome advantage over IVF in patients with non-male factor infertility?
We did not find any outcome improvement that justifies the routine use of ICSI over IVF in non-male factor ART cycles.
Since its introduction in Latin America, the use of ICSI has increased substantially, even among patients without male factor infertility. However, it is not clear whether ICSI provides an advantage over IVF in non-male factor infertility.
A retrospective cohort study of fresh cycles performed in 155 ART clinics located in 15 Latin American countries between 2012 and 2014. Records were assessed for 49,813 ART cycles (39,564 ICSI and 10,249 IVF) performed in infertile couples who did not have male factor infertility. Student's -test was used to analyze normally distributed data, Wilcoxon test to analyze non-normally distributed data, and Fisher's exact test for categorical data. Logistic regression was used to quantify the effect of ICSI on delivery rate, adjusting for age of female partner, number of oocytes inseminated, number of embryos transferred, and transfer at blastocyst stage as possible confounding factors. Poisson regression analysis was used to quantify the effect of ICSI on fertilization rate, adjusting for age of female partner.
PARTICIPANTS/MATERIALS SETTING METHOD: Cycles with the diagnosis of male factor and use of cryopreserved semen and with a freeze-all strategy were excluded.
After correcting for age of female partner, number of oocytes inseminated, number of embryos transferred and transfer at blastocyst stage, we found that the use of ICSI was associated with a significant decrease in the odds of delivery compared to IVF (odds ratio 0.88, 95% CI 0.84 to 0.93; < 0.0001).
An important limitation of this study is the lack of randomization owing to its retrospective nature. This could result in selection bias, i.e. couples with the worst prognosis undergoing ICSI, or patients with a history of fertilization failure in IVF cycles undergoing ICSI. More than one cycle from the same couple may be included in the study.
The lack of an outcome benefit-and, indeed, a reduced likelihood of delivery-following ICSI in non-male factor infertile couples suggests that ICSI may not be the most appropriate clinical approach in these patients.
STUDY FUNDING/COMPETING INTERESTS: None.
对于非男性因素导致不孕的患者，与体外受精（IVF）相比，卵胞浆内单精子注射（ICSI）的应用是否能带来更好的结局？
我们并未发现任何结局改善情况能够证明在非男性因素的辅助生殖技术（ART）周期中常规使用ICSI优于IVF。
自ICSI在拉丁美洲引入以来，其使用量大幅增加，即便在没有男性因素不孕的患者中也是如此。然而，尚不清楚ICSI在非男性因素不孕方面是否比IVF具有优势。
研究设计、规模、持续时间：一项回顾性队列研究，研究对象为2012年至2014年间在15个拉丁美洲国家的155家ART诊所进行的新鲜周期。对没有男性因素不孕的不育夫妇所进行的49813个ART周期（39564个ICSI周期和10249个IVF周期）的记录进行评估。采用学生t检验分析正态分布数据，采用威尔科克森检验分析非正态分布数据，采用费舍尔精确检验分析分类数据。使用逻辑回归来量化ICSI对分娩率的影响，并将女性伴侣年龄、受精的卵母细胞数量、移植的胚胎数量以及囊胚期移植作为可能的混杂因素进行校正。采用泊松回归分析来量化ICSI对受精率的影响，并对女性伴侣年龄进行校正。
参与者/材料、环境、方法：排除诊断为男性因素且使用冷冻精液以及采用全冷冻策略的周期。
在校正女性伴侣年龄、受精的卵母细胞数量、移植的胚胎数量以及囊胚期移植后，我们发现与IVF相比，使用ICSI与分娩几率显著降低相关（优势比0.88，95%置信区间0.84至0.93；P<0.0001）。
局限性、谨慎原因：本研究的一个重要局限性在于其回顾性性质导致缺乏随机分组。这可能导致选择偏倚，即预后最差的夫妇接受ICSI，或者在IVF周期中有受精失败史的患者接受ICSI。同一对夫妇可能有不止一个周期被纳入研究。
在非男性因素不孕夫妇中，ICSI缺乏结局益处，实际上分娩可能性降低，这表明ICSI可能并非这些患者最适宜的临床方法。
研究资金/利益冲突：无。
