PDF(Pubmed)
Abstract：
OBJECTIVE: To investigate the impact of heterogeneity in patient indications or insemination protocols on neonatal outcomes of singletons following early rescue ICSI (rICSI) treatments.
METHODS: A retrospective study was conducted. Propensity score matching and multivariable logistic regression were used to adjust for confounders and biases.
RESULTS: A total of 9095 IVF patients, 2063 ICSI patients, and 642 early rICSI patients were included in the study. No differences were detected in neonatal outcomes except small for gestational age (SGA) which increased in early rICSI patients compared with both unmatched and matched IVF groups with the risk ratio (RR) of 1.31 (95% CI: 1.05, 1.64) and 1.49 (95% CI: 1.05, 2.12). Further analysis showed that SGA increased significantly in partial fertilization failure (PFF) cycles with RRs of 1.56 (95% CI: 1.08, 2.27) and 1.78 (95% CI: 1.22, 2.59) compared with both unmatched and matched IVF patients but not in TFF patients. A positive association between fertilization rate via IVF and birth weight z-score was revealed in the PFF patients.
CONCLUSIONS: Early rICSI in patients with total fertilization failure (TFF) appeared to be safe in terms of neonatal outcomes. However, when expanding the indications of rICSI to PFF patients, the SGA in the offspring increased, suggesting a potential effect on long-term health. Since other treatment options, such as using only the IVF-origin embryos still exist for these patients, further studies were needed to confirm the optimal decision for these patients.
METHODS: A retrospective study was conducted. Propensity score matching and multivariable logistic regression were used to adjust for confounders and biases.
RESULTS: A total of 9095 IVF patients, 2063 ICSI patients, and 642 early rICSI patients were included in the study. No differences were detected in neonatal outcomes except small for gestational age (SGA) which increased in early rICSI patients compared with both unmatched and matched IVF groups with the risk ratio (RR) of 1.31 (95% CI: 1.05, 1.64) and 1.49 (95% CI: 1.05, 2.12). Further analysis showed that SGA increased significantly in partial fertilization failure (PFF) cycles with RRs of 1.56 (95% CI: 1.08, 2.27) and 1.78 (95% CI: 1.22, 2.59) compared with both unmatched and matched IVF patients but not in TFF patients. A positive association between fertilization rate via IVF and birth weight z-score was revealed in the PFF patients.
CONCLUSIONS: Early rICSI in patients with total fertilization failure (TFF) appeared to be safe in terms of neonatal outcomes. However, when expanding the indications of rICSI to PFF patients, the SGA in the offspring increased, suggesting a potential effect on long-term health. Since other treatment options, such as using only the IVF-origin embryos still exist for these patients, further studies were needed to confirm the optimal decision for these patients.
摘要：
目的：研究患者适应症或授精方案的异质性对早期抢救ICSI（rICSI）治疗后单胎新生儿结局的影响。
方法：进行回顾性研究。使用倾向得分匹配和多变量逻辑回归来校正混杂因素和偏差。
结果：总共9095例IVF患者，2063例ICSI患者，本研究纳入了642例早期rICSI患者。与未匹配和匹配的IVF组相比，早期rICSI患者的胎龄小（SGA）增加，新生儿结局无差异，风险比（RR）为1.31（95％CI：1.05，1.64）和1.49（95％CI：1.05，2.12）。进一步的分析表明，与不匹配和匹配的IVF患者相比，部分受精失败（PFF）周期的SGA显着增加，RRs分别为1.56（95％CI：1.08，2.27）和1.78（95％CI：1.22，2.59）。在PFF患者中，通过IVF的受精率与出生体重z评分之间呈正相关。
结论：完全受精失败（TFF）患者的早期rICSI在新生儿结局方面似乎是安全的。然而,当将rICSI的适应症扩展到PFF患者时，后代的SGA增加了，表明对长期健康的潜在影响。由于其他治疗选择，例如仅使用IVF来源的胚胎仍然存在于这些患者中，需要进一步的研究来确认这些患者的最佳决策.
方法：进行回顾性研究。使用倾向得分匹配和多变量逻辑回归来校正混杂因素和偏差。
结果：总共9095例IVF患者，2063例ICSI患者，本研究纳入了642例早期rICSI患者。与未匹配和匹配的IVF组相比，早期rICSI患者的胎龄小（SGA）增加，新生儿结局无差异，风险比（RR）为1.31（95％CI：1.05，1.64）和1.49（95％CI：1.05，2.12）。进一步的分析表明，与不匹配和匹配的IVF患者相比，部分受精失败（PFF）周期的SGA显着增加，RRs分别为1.56（95％CI：1.08，2.27）和1.78（95％CI：1.22，2.59）。在PFF患者中，通过IVF的受精率与出生体重z评分之间呈正相关。
结论：完全受精失败（TFF）患者的早期rICSI在新生儿结局方面似乎是安全的。然而,当将rICSI的适应症扩展到PFF患者时，后代的SGA增加了，表明对长期健康的潜在影响。由于其他治疗选择，例如仅使用IVF来源的胚胎仍然存在于这些患者中，需要进一步的研究来确认这些患者的最佳决策.
