Purpose

We performed a systematic review and meta-analysis of available literature to investigate the efficacy of the intracytoplasmic sperm injection (ICSI) in couples with non-male factor with respect to the clinical outcomes.

Methods

The literature search was based on EMBASE, PubMed, and the Cochrane Library. All studies published after 1992 until February 2020 and written in English addressing patients in the presence of normal semen parameters subjected to ICSI and in vitro fertilization (IVF) were eligible. Reference lists of retrieved articles were hand-searched for additional studies. The primary outcomes were fertilization rate, clinical pregnancy rate, and implantation rate; the secondary outcomes were good-quality embryo rate, miscarriage rate, and live birth rate.

Results

Four RCTs and twenty-two cohort studies fulfilling the inclusion criteria were included. Collectively, a meta-analysis of the outcomes in RCTs showed that compared to IVF, ICSI has no obvious advantage in fertilization rate (RR = 1.16, 95% CI: 0.83–1.62), clinical pregnancy rate (RR = 1.04, 95% CI: 0.66–1.64), implantation rate (RR = 1.12, 95% CI: 0.67–1.86), and live birth rate (RR = 1.17, 95% CI: 0.43–3.15). Pooled results of cohort studies demonstrated a statistically significant higher fertilization rate (RR = 1.16, 95% CI: 1.03–1.31) and miscarriage rate (RR = 1.04, 95% CI: 1.01–1.06) in the ICSI group; furthermore, higher clinical pregnancy rate (RR = 0.85, 95% CI: 0.77–0.94), implantation rate (RR = 0.78, 95% CI: 0.65–0.95), and live birth rate (RR = 0.86, 95% CI: 0.79–0.94) was founded in the IVF group; no statistically significant difference was observed in good-quality embryo rate (RR = 0.98, 95% CI: 0.93–1.04).

Conclusion

ICSI has no obvious advantage in patients with normal semen parameters. Enough information is still not available to prove the efficacy of ICSI in couples with non-male factor infertility comparing to IVF.

中文翻译：

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ICSI 对非男性因素不孕夫妇的影响：系统评价和荟萃分析

 目的

我们对现有文献进行了系统回顾和荟萃分析，以研究胞浆内单精子注射（ICSI）对非男性因素夫妇的临床结果的疗效。

 方法

文献检索基于 EMBASE、PubMed 和 Cochrane 图书馆。 1992 年之后至 2020 年 2 月发表的所有研究均以英文撰写，涉及精液参数正常且接受 ICSI 和体外受精 (IVF) 的患者。手动检索检索到的文章的参考列表以进行其他研究。主要结局为受精率、临床妊娠率和着床率；次要结局是优质胚胎率、流产率和活产率。

 结果

纳入了四项随机对照试验和二十二项符合纳入标准的队列研究。总体而言，对RCT结果的荟萃分析表明，与IVF相比，ICSI在受精率（RR=1.16，95%CI：0.83-1.62）、临床妊娠率（RR=1.04，95%CI：0.83-1.62）、临床妊娠率（RR=1.04，95%CI）方面没有明显优势。 ：0.66–1.64）、着床率（RR = 1.12，95% CI：0.67–1.86）和活产率（RR = 1.17，95% CI：0.43–3.15）。队列研究的汇总结果表明，ICSI 组的受精率（RR = 1.16，95% CI：1.03–1.31）和流产率（RR = 1.04，95% CI：1.01–1.06）具有统计学显着性较高；此外，临床妊娠率（RR = 0.85，95% CI：0.77–0.94）、着床率（RR = 0.78，95% CI：0.65–0.95）和活产率（RR = 0.86，95% CI：0.79）更高–0.94）创立于IVF组；优质胚胎率没有观察到统计学上的显着差异（RR = 0.98，95% CI：0.93-1.04）。

 结论

ICSI对于精液参数正常的患者没有明显优势。目前还没有足够的信息来证明 ICSI 与 IVF 相比对非男性因素不孕夫妇的疗效。