Geng Ting, Cheng Lin, Ge Caiyun, Zhang Yuanzhen
Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, 430071, Hubei, People's Republic of China.
J Assist Reprod Genet. 2020 Dec;37(12):2929-2945. doi: 10.1007/s10815-020-01970-9. Epub 2020 Oct 19.
We performed a systematic review and meta-analysis of available literature to investigate the efficacy of the intracytoplasmic sperm injection (ICSI) in couples with non-male factor with respect to the clinical outcomes.
The literature search was based on EMBASE, PubMed, and the Cochrane Library. All studies published after 1992 until February 2020 and written in English addressing patients in the presence of normal semen parameters subjected to ICSI and in vitro fertilization (IVF) were eligible. Reference lists of retrieved articles were hand-searched for additional studies. The primary outcomes were fertilization rate, clinical pregnancy rate, and implantation rate; the secondary outcomes were good-quality embryo rate, miscarriage rate, and live birth rate.
Four RCTs and twenty-two cohort studies fulfilling the inclusion criteria were included. Collectively, a meta-analysis of the outcomes in RCTs showed that compared to IVF, ICSI has no obvious advantage in fertilization rate (RR = 1.16, 95% CI: 0.83-1.62), clinical pregnancy rate (RR = 1.04, 95% CI: 0.66-1.64), implantation rate (RR = 1.12, 95% CI: 0.67-1.86), and live birth rate (RR = 1.17, 95% CI: 0.43-3.15). Pooled results of cohort studies demonstrated a statistically significant higher fertilization rate (RR = 1.16, 95% CI: 1.03-1.31) and miscarriage rate (RR = 1.04, 95% CI: 1.01-1.06) in the ICSI group; furthermore, higher clinical pregnancy rate (RR = 0.85, 95% CI: 0.77-0.94), implantation rate (RR = 0.78, 95% CI: 0.65-0.95), and live birth rate (RR = 0.86, 95% CI: 0.79-0.94) was founded in the IVF group; no statistically significant difference was observed in good-quality embryo rate (RR = 0.98, 95% CI: 0.93-1.04).
ICSI has no obvious advantage in patients with normal semen parameters. Enough information is still not available to prove the efficacy of ICSI in couples with non-male factor infertility comparing to IVF.
我们对现有文献进行了系统评价和荟萃分析，以研究胞浆内单精子注射（ICSI）在非男性因素夫妇中的临床疗效。
文献检索基于EMBASE、PubMed和Cochrane图书馆。纳入所有1992年后至2020年2月发表的、用英文撰写的、针对精液参数正常且接受ICSI和体外受精（IVF）的患者的研究。对检索到的文章的参考文献列表进行手工检索以寻找其他研究。主要结局为受精率、临床妊娠率和着床率；次要结局为优质胚胎率、流产率和活产率。
纳入了4项随机对照试验（RCT）和22项队列研究，这些研究均符合纳入标准。总体而言，RCT结局的荟萃分析表明，与IVF相比，ICSI在受精率（RR = 1.16，95%CI：0.83 - 1.62）、临床妊娠率（RR = 1.04，95%CI：0.66 - 1.64）、着床率（RR = 1.12，95%CI：0.67 - 1.86）和活产率（RR = 1.17，95%CI：0.43 - 3.15）方面无明显优势。队列研究的汇总结果显示，ICSI组的受精率（RR = 1.16，95%CI：1.03 - 1.31）和流产率（RR = 1.04，95%CI：1.01 - 1.06）在统计学上显著更高；此外，IVF组的临床妊娠率（RR = 0.85，95%CI：0.77 - 0.94）、着床率（RR = 0.78，95%CI：0.65 - 0.95）和活产率（RR = 0.86，95%CI：0.79 - 0.94）更高；优质胚胎率方面未观察到统计学显著差异（RR = 0.98，95%CI：0.93 - 1.04）。
对于精液参数正常的患者，ICSI无明显优势。与IVF相比，仍没有足够信息证明ICSI在非男性因素不孕夫妇中的疗效。
