Song Jianyuan, Liao Tingting, Fu Kaiyou, Xu Jian
The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.
Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Med (Lausanne). 2021 Feb 10;7:614118. doi: 10.3389/fmed.2020.614118. eCollection 2020.
Unexplained infertility has been one of the indications for utilization of intracytoplasmic sperm injection (ICSI). However, whether ICSI should be preferred to IVF for patients with unexplained infertility remains an open question. This study aims to determine if ICSI improves the clinical outcomes over conventional fertilization (IVF) in couples with unexplained infertility. This was a retrospective cohort study of 549 IVF and 241 ICSI cycles for patients with unexplained infertility at a fertility center of a university hospital from January 2016 and December 2018. The live birth rate and clinical pregnancy rate were compared between the two groups. Other outcome measures included the implantation rate, miscarriage rate, and fertilization rate. The live birth rate was 35.2% (172/488) in the IVF group and 33.3% (65/195) in ICSI group, = 0.635. The two groups also had similar clinical pregnancy rates, implantation rates, and miscarriage rates. The fertilization rate of IVF group was significantly higher than that of ICSI group (53.8 vs. 45.7%, = 0.000, respectively). Sixty-one and 46 patients did not transfer fresh embryos in IVF and ICSI cycles, respectively. Patients with IVF cycles had lower cancellation rates than those with ICSI (11.1 vs. 19.1%, = 0.003, respectively). ICSI does not improve live birth rates but yields higher cancellation rates than conventional IVF in the treatment of unexplained infertility.
不明原因不孕一直是卵胞浆内单精子注射（ICSI）的应用指征之一。然而，对于不明原因不孕患者，ICSI是否应优于体外受精（IVF）仍是一个悬而未决的问题。本研究旨在确定在不明原因不孕的夫妇中，ICSI是否比传统受精（IVF）能改善临床结局。这是一项回顾性队列研究，纳入了2016年1月至2018年12月在一所大学医院生殖中心进行治疗的549个IVF周期和241个ICSI周期的不明原因不孕患者。比较了两组的活产率和临床妊娠率。其他结局指标包括着床率、流产率和受精率。IVF组的活产率为35.2%（172/488），ICSI组为33.3%（65/195），P = 0.635。两组的临床妊娠率、着床率和流产率也相似。IVF组的受精率显著高于ICSI组（分别为53.8%和45.7%，P = 0.000）。IVF周期和ICSI周期分别有61例和46例患者未移植新鲜胚胎。IVF周期患者的取消率低于ICSI周期患者（分别为11.1%和19.1%，P = 0.003）。在不明原因不孕的治疗中，ICSI并不能提高活产率，但取消率高于传统IVF。
