Freemasons Center for Male Health and Wellbeing, The University of Adelaide, Adelaide, SA, 5005, Australia.
Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia.
J Assist Reprod Genet. 2021 Mar;38(3):669-678. doi: 10.1007/s10815-020-02026-8. Epub 2021 Jan 7.
To determine if the use of ICSI in women of advanced maternal age with non-male factor infertility increases chances of live birth.
Retrospective data analysis of 10 years of cycle data from a single Australian IVF clinic (Repromed). First cycle patients only of an advanced maternal age (≥ 35 years) with non-male factor infertility utilising standard IVF or ICSI insemination and having at least three oocytes collected at egg pick up were assessed for live birth following transfer of single genetically unscreened blastocyst (N = 577). Subanalysis of clinical pregnancy, miscarriage, fertilisation, embryo utilisation rate and having a blastocyst for transfer were considered. Unadjusted, covariate adjusted and propensity score weighted analysis were performed.
The use of standard IVF insemination in women ≥ 35 years with non-male factor infertility increased the chance of a live birth compared with ICSI insemination (unadjusted OR = 2.72, 95% CI [1.78, 4.17]; adjusted OR = 2.64, 95% CI [1.64, 4.27] and weighted OR = 2.26, 95% CI [1.72, 2.98] 31% vs 14%). All other outcomes (fertilisation rate, embryo utilisation, blastocyst for embryo transfer and miscarriage rate) were unaffected.
In couples with advanced maternal age and non-male factor infertility, standard IVF insemination appears to increase the chance of a live birth compared with ICSI. As such, the results of this study support the use of routine IVF as the preferred insemination technique for older women in non-male factor infertility. However, future randomised controlled trials are still required to assess this policy.
确定在高龄、非男性因素不孕的女性中使用卵胞浆内单精子注射（ICSI）是否会增加活产几率。
对澳大利亚一家体外受精（IVF）诊所（Repromed）的 10 年周期数据进行回顾性数据分析。仅纳入年龄较大（≥35 岁）、非男性因素不孕、采用标准 IVF 或 ICSI 授精且在取卵时至少收集 3 个卵母细胞的初诊患者，评估在单个未经基因筛查的囊胚移植后活产的情况（N=577）。对临床妊娠、流产、受精、胚胎利用率和有囊胚用于移植进行亚分析。进行了未调整、协变量调整和倾向评分加权分析。
在非男性因素不孕的高龄女性中，与 ICSI 授精相比，标准 IVF 授精增加了活产的几率（未调整 OR=2.72，95%CI[1.78, 4.17]；调整 OR=2.64，95%CI[1.64, 4.27]；加权 OR=2.26，95%CI[1.72, 2.98]，31%对 14%）。所有其他结局（受精率、胚胎利用率、用于胚胎移植的囊胚和流产率）均未受影响。
在高龄且非男性因素不孕的夫妇中，与 ICSI 相比，标准 IVF 授精似乎增加了活产的几率。因此，本研究结果支持在非男性因素不孕的高龄女性中常规使用 IVF 作为首选授精技术。然而，仍需要未来的随机对照试验来评估这一政策。
