Glenn Tanya L, Kotlyar Alex M, Seifer David B
Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Reproductive Endocrinology and Infertility, Yale University School of Medicine, New Haven, CT 06520, USA.
J Clin Med. 2021 Jun 14;10(12):2616. doi: 10.3390/jcm10122616.
Intracytoplasmic sperm injection (ICSI) was originally designed to overcome barriers due to male factor infertility. However, a surveillance study found that ICSI use in non-male factor infertility increased from 15.4% to 66.9% between 1996 and 2012. Numerous studies have investigated fertilization rate, total fertilization failure, and live birth rate per cycle (LBR), comparing the use of ICSI versus conventional in vitro fertilization (IVF) for non-male factor infertility. The overwhelming conclusion shows no increase in fertilization rate or LBR per cycle with the use of ICSI for non-male factor infertility. The overuse of ICSI is likely related to the desire to avoid a higher rate of total fertilization failure in IVF. However, data supporting the benefit of using ICSI for non-male factor infertility is lacking, and 33 couples would need to be treated with ICSI unnecessarily to avoid one case of total fertilization failure. Such practice increases the cost to the patient, increases the burden on embryologist's time, and is a misapplication of resources. Additionally, there remains conflicting data regarding the safety of offspring conceived by ICSI and potential damage to the oocyte. Thus, the use of ICSI should be limited to those with male factor infertility or a history of total fertilization factor infertility due to uncertainties of potential adverse impact and lack of proven benefit in non-male factor infertility.
卵胞浆内单精子注射（ICSI）最初旨在克服男性因素导致的不孕障碍。然而，一项监测研究发现，1996年至2012年间，非男性因素不孕中ICSI的使用比例从15.4%增至66.9%。众多研究调查了受精率、完全受精失败率以及每个周期的活产率（LBR），比较了在非男性因素不孕中使用ICSI与传统体外受精（IVF）的情况。压倒性的结论表明，在非男性因素不孕中使用ICSI并不会提高每个周期的受精率或活产率。ICSI的过度使用可能与避免IVF中较高的完全受精失败率的愿望有关。然而，缺乏支持在非男性因素不孕中使用ICSI有益的数据，而且为避免一例完全受精失败，需要对33对夫妇进行不必要的ICSI治疗。这种做法增加了患者的费用，增加了胚胎学家的时间负担，并且是资源的误用。此外，关于ICSI受孕后代的安全性以及对卵母细胞的潜在损害，仍存在相互矛盾的数据。因此，由于潜在负面影响的不确定性以及在非男性因素不孕中缺乏已证实的益处，ICSI的使用应仅限于男性因素不孕或有完全受精失败史的患者。
