Singh Neeta, Malhotra Neena, Mahey Reeta, Kumari Supriya, Saini Monika
Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India.
J Hum Reprod Sci. 2025 Jan-Mar;18(1):9-15. doi: 10.4103/jhrs.jhrs_157_24. Epub 2025 Mar 29.
In unexplained infertility (UI), the use of intracytoplasmic sperm injection (ICSI) has been increased to prevent total fertilisation failure (TFF). However, there is little evidence to support improved clinical outcomes.
The aim of the study was to assess whether ICSI improves the outcomes compared to conventional fertilisation (IVF) in UI.
A retrospective cohort study in a tertiary centre.
Patients were divided into two groups. Group A in which ICSI-cycles were performed and Group B in which IVF-cycles were performed. All UI couples with females aged between 21 and 38 years who underwent the first long GnRH-agonist or GnRH-antagonist protocol stimulation cycle followed by fresh embryo transfer were included. UI couples who needed rescue-ICSI, donor-recipient cycles and pre-implantation genetic diagnosis were excluded. Outcomes were fertilisation rate, TFF, good-quality day 3 embryo, implantation rate, miscarriage rate and clinical pregnancy rate.
STATA 18.0 software (Stata Corp, TX, USA) was used.
A total of 511 UI patients were included out of which 182 underwent ICSI and 310 underwent IVF cycles. Baseline characteristics were similar in both groups. The mean percentage fertilisation rate was comparable in the ICSI and IVF groups (67.18 ± 22.61 vs. 66.93 ± 26.66, = 0.92, respectively). TFF was lower in the ICSI group compared to the IVF group (2.7% vs. 5.8%, = 0.12). The mean number of good-quality embryo development rate on day 3 was similar between the ICSI and IVF groups ( = 0.93). Although implantation and clinical pregnancy rates were higher in the IVF group compared to the ICSI group with > 0.05, these differences were not statistically significant.
The study reported reduced TFF in the ICSI group in comparison to the IVF group but was not statistically significant with comparable clinical outcomes.
在不明原因不孕症（UI）中，卵胞浆内单精子注射（ICSI）的使用有所增加，以预防完全受精失败（TFF）。然而，几乎没有证据支持其能改善临床结局。
本研究旨在评估在不明原因不孕症中，与传统受精（IVF）相比，ICSI是否能改善结局。
在一家三级中心进行的回顾性队列研究。
将患者分为两组。A组进行ICSI周期，B组进行IVF周期。纳入所有年龄在21至38岁之间、接受首次长效促性腺激素释放激素（GnRH）激动剂或GnRH拮抗剂方案刺激周期并随后进行新鲜胚胎移植的不明原因不孕症夫妇。排除需要补救性ICSI、供体-受体周期和植入前基因诊断的不明原因不孕症夫妇。结局指标为受精率、完全受精失败率、优质第3天胚胎率、着床率、流产率和临床妊娠率。
使用STATA 18.0软件（美国德克萨斯州Stata公司）。
共纳入511例不明原因不孕症患者，其中182例接受了ICSI，310例接受了IVF周期。两组的基线特征相似。ICSI组和IVF组的平均受精率百分比相当（分别为67.18±22.61和66.93±26.66，P = 0.92）。ICSI组的完全受精失败率低于IVF组（2.7%对5.8%，P = 0.12）。ICSI组和IVF组第3天优质胚胎发育率的平均数相似（P = 0.93）。尽管IVF组的着床率和临床妊娠率高于ICSI组，P>0.05，但这些差异无统计学意义。
该研究报告称，与IVF组相比，ICSI组的完全受精失败率降低，但在临床结局相当的情况下无统计学意义。
