背景:在辅助生殖技术(ART)中,对于女性或原因不明的不孕症夫妇来说,选择卵胞浆内单精子注射(ICSI)和常规体外受精(IVF)仍然是一个关键的决定.这项研究探讨了以下假设:在没有男性不育因素的情况下,ICSI可能不会显着改善活产率。
方法:这是2005年至2018年英国人类受精和胚胎学管理局(HFEA)记录的数据的回顾性收集,并通过整个数据集和配对子集的回归分析模型进行分析。根据授精技术分析了第一个新鲜的ART周期,以比较活产作为主要结果。如果关于不孕症原因的完整信息,包括周期,女性年龄,回收的卵母细胞数量,分配给ICSI或IVF,并且可以获得活产方面的治疗结果.根据不孕症的原因,在IVF和ICSI周期之间以1:1的比例进行匹配,女性年龄,卵母细胞数量,和治疗年份。
结果:这项研究,基于275,825个第一周期,透露,与IVF相比,ICSI与较高的受精率和较低的周期取消率相关。然而,ICSI与植入和活产的机会比IVF更低的女性不孕周期:在整个数据集中,调整后的活产几率降低了0.95倍(95%CI0.91-0.99,p=0.011),而在配对分析中,与IVF相比,使用ICSI时它减少了0.91倍(95%CI0.86-0.96,p=0.003)。对于无法解释的不孕周期,在整个数据集中,与IVF周期相比,ICSI中活产的校正比值比为0.98(95%CI0.95-1.01),配对分析为0.97(95%CI0.93-1.01).
结论:与IVF相比,由于女性因素,ICSI与接受ART治疗时活产减少有关。此外,在无法解释的不孕症的周期中使用ICSI没有显著改善.我们的发现对只有女性因素和无法解释的不孕症的病例使用ICSI而不是IVF进行了严格的重新评估。
BACKGROUND: In assisted reproductive technology (ART), the choice between intracytoplasmic sperm injection (ICSI) and conventional in vitro insemination (IVF) remains a pivotal decision for couples with female or unexplained infertility. The hypothesis that ICSI may not confer significant improvements in live birth rates in the absence of a male infertility factor was explored in this study.
METHODS: This was a retrospective collection of data recorded by the Human Fertilisation and Embryology Authority (HFEA) in the UK from 2005 to 2018 and analysed through regression analysis models on both the entire dataset and a matched-pair subset. First fresh ART cycles were analysed according to the insemination technique in order to compare live birth as the main outcome. Cycles were included if complete information regarding infertility cause, female age, number of oocytes retrieved, allocation to ICSI or IVF, and treatment outcome in terms of live birth was available. Matching was performed at a 1:1 ratio between IVF and ICSI cycles according to the cause of infertility, female age, number of oocytes, and year of treatment.
RESULTS: This study, based on 275,825 first cycles, revealed that, compared with IVF, ICSI was associated with higher fertilization rates and lower cycle cancellations rates. However, ICSI was associated with a lower chance of implantation and live birth than IVF in cycles with female-only infertility: in the entire dataset, the adjusted odds of having a live birth decreased by a factor of 0.95 (95% CI 0.91-0.99, p = 0.011), while in the matched-pair analyses it decreased by a factor of 0.91 (95% CI 0.86-0.96, p = 0.003) using ICSI compared to IVF. For unexplained infertility cycles, the adjusted odds ratios for live birth in ICSI compared to IVF cycles were 0.98 (95% CI 0.95-1.01) in the entire dataset and 0.97 (95% CI 0.93-1.01) in the matched-pair analysis.
CONCLUSIONS: Compared with IVF, ICSI was associated with a reduction in live births when ART was indicated due to female-only factors. Additionally, no significant improvements were associated with the use of ICSI in cycles with unexplained infertility. Our findings impose a critical reevaluation regarding the use of ICSI over IVF for cases with female-only factors and unexplained infertility.