Huang Jun-Xia, Gao Yu-Qi, Chen Xiao-Tong, Han Ying-Qi, Song Jing-Yan, Sun Zhen-Gao
The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
School of Acupuncture, Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China.
Front Reprod Health. 2022 Oct 28;4:1029381. doi: 10.3389/frph.2022.1029381. eCollection 2022.
The purpose of this study is to determine whether intracytoplasmic sperm injection (ICSI) is beneficial in patients with non-male factor infertility.
This systematic review and meta-analysis included articles from inception to May 2022. Published studies of non-male factor infertile women undergoing ICSI or fertilization (IVF) included in PubMed, Embase, web of science, Wanfang Database, and CNKI were searched by computer, without language restrictions. A random-effect model was applied to calculate the risk ratios (RRs) and their 95% confidence intervals (CIs). Letters, case reports, and review articles including meta-analyses and expert opinions were excluded. The primary endpoints were laboratory outcomes and pregnancy outcomes. The Secondary endpoints were neonatal outcomes.
Six randomized controlled studies and 20 retrospective cohort studies met the inclusion criteria. In meta-analytic forest plots, compared with IVF, those who received ICSI treatment were not different in fertilization rate (RR = 0.99, 95% CI [0.90-1.09], = 0.88), total fertilization failure rate (RR = 1.30, 95% CI [1.17-1.45], < 0.00001), and good quality embryo rate (RR = 0.94, 95% CI [ 0.86-1.02], = 0.15), clinical pregnancy rate (RR = 0.84, 95% CI [0.70-1.01], = 0.06), live birth rate (RR = 0.89, 95% CI [0.77-1.03], = 0.13), miscarriage rate (RR = 1.06, 95% CI [0.78-1.43], = 0.71), preterm neonatal delivery rate (RR = 0.92, 95% CI [0.67-1.26], = 0.61), and low neonatal weight rate (RR = 1.13, 95% CI [0.80-1.61], = 0.48). However, the implantation rate of IVF was better than ICSI (RR = 0.77, 95% CI [0.64-0.93], = 0.005). In the subgroup analysis of the live birth rate of fresh embryo transfer, IVF performed in those ≥35 years had a higher live birth rate (RR = 0.82, 95% CI [0.78-0.83], < 0.001).
The findings of this study indicate that ICSI is not superior to IVF in the treatment of infertility related to non-male factors. In order to confirm this result, more high-quality clinical studies are needed.
本研究旨在确定卵胞浆内单精子注射（ICSI）对非男性因素不孕患者是否有益。
本系统评价和荟萃分析纳入了从研究开始至2022年5月的文章。通过计算机检索PubMed、Embase、科学网、万方数据库和中国知网中发表的关于接受ICSI或体外受精（IVF）的非男性因素不孕女性的研究，无语言限制。采用随机效应模型计算风险比（RRs）及其95%置信区间（CIs）。排除信件、病例报告以及包括荟萃分析和专家意见在内的综述文章。主要终点为实验室结局和妊娠结局。次要终点为新生儿结局。
六项随机对照研究和二十项回顾性队列研究符合纳入标准。在荟萃分析森林图中，与IVF相比，接受ICSI治疗者在受精率（RR = 0.99，95%CI[0.90 - 1.09]，P = 0.88）、完全受精失败率（RR = 1.30，95%CI[1.17 - 1.45]，P < 0.00001）、优质胚胎率（RR = 0.94，95%CI[0.86 - 1.02]，P = 0.15）、临床妊娠率（RR = 0.84，95%CI[0.70 - 1.01]，P = 0.06）、活产率（RR = 0.89，95%CI[0.77 - 1.03]，P = 0.13）、流产率（RR = 1.06，95%CI[0.78 - 1.43]，P = 0.71）、早产新生儿出生率（RR = 0.92，95%CI[0.67 - 1.26]，P = 0.61）以及低出生体重率（RR = 1.13，95%CI[0.80 - 1.61]，P = 0.48）方面无差异。然而，IVF的着床率优于ICSI（RR = 0.77，95%CI[0.64 - 0.93]，P = 0.005）。在新鲜胚胎移植活产率的亚组分析中，35岁及以上人群接受IVF的活产率更高（RR = 0.82，95%CI[0.78 - 0.83]，P < 0.001）。
本研究结果表明，在治疗非男性因素相关不孕方面，ICSI并不优于IVF。为证实这一结果，需要更多高质量的临床研究。
