Purpose

To determine if the use of ICSI in women of advanced maternal age with non-male factor infertility increases chances of live birth.

Methods

Retrospective data analysis of 10 years of cycle data from a single Australian IVF clinic (Repromed). First cycle patients only of an advanced maternal age (≥ 35 years) with non-male factor infertility utilising standard IVF or ICSI insemination and having at least three oocytes collected at egg pick up were assessed for live birth following transfer of single genetically unscreened blastocyst (N = 577). Subanalysis of clinical pregnancy, miscarriage, fertilisation, embryo utilisation rate and having a blastocyst for transfer were considered. Unadjusted, covariate adjusted and propensity score weighted analysis were performed.

Results

The use of standard IVF insemination in women ≥ 35 years with non-male factor infertility increased the chance of a live birth compared with ICSI insemination (unadjusted OR = 2.72, 95% CI [1.78, 4.17]; adjusted OR = 2.64, 95% CI [1.64, 4.27] and weighted OR = 2.26, 95% CI [1.72, 2.98] 31% vs 14%). All other outcomes (fertilisation rate, embryo utilisation, blastocyst for embryo transfer and miscarriage rate) were unaffected.

Conclusion

In couples with advanced maternal age and non-male factor infertility, standard IVF insemination appears to increase the chance of a live birth compared with ICSI. As such, the results of this study support the use of routine IVF as the preferred insemination technique for older women in non-male factor infertility. However, future randomised controlled trials are still required to assess this policy.

中文翻译：

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体外受精/胞浆内单精子注射对非男性因素不孕症和高龄产妇活产率的比较

目的

确定在患有非男性因素不孕症的高龄产妇中使用 ICSI 是否会增加活产的机会。

方法

来自澳大利亚一家 IVF 诊所 (Repromed) 的 10 年周期数据的回顾性数据分析。使用标准 IVF 或 ICSI 授精并在取卵时收集至少三个卵母细胞的非男性因素不育的高龄产妇（≥ 35 岁）的第一周期患者在转移单个未经基因筛选的囊胚后进行活产评估（N  = 577)。考虑了临床妊娠、流产、受精、胚胎利用率和囊胚移植的亚分析。进行了未调整、协变量调整和倾向得分加权分析。

结果

与 ICSI 人工授精相比，在 ≥ 35 岁的非男性因素不孕症女性中使用标准 IVF 人工授精增加了活产的机会（未调整的 OR = 2.72, 95% CI [1.78, 4.17]；调整后的 OR = 2.64, 95% CI [1.64, 4.27] 和加权 OR = 2.26, 95% CI [1.72, 2.98] 31% vs 14%）。所有其他结果（受精率、胚胎利用、胚胎移植的囊胚和流产率）均未受影响。

结论

在高龄产妇和非男性因素不育的夫妇中，与 ICSI 相比，标准 IVF 授精似乎增加了活产的机会。因此，本研究的结果支持使用常规体外受精作为非男性因素不孕症老年女性的首选授精技术。然而，仍需要未来的随机对照试验来评估这一政策。