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A systematic review and meta-analysis on the association between ICSI and chromosome abnormalities.
Human Reproduction Update ( IF 13.3 ) Pub Date : 2021-05-06 , DOI: 10.1093/humupd/dmab005
Sine Berntsen 1 , Hannele Laivuori 2, 3, 4, 5 , Nina la Cour Freiesleben 1 , Anne Loft 6 , Viveca Söderström-Anttila 7 , Nan B Oldereid 8 , Liv Bente Romundstad 9, 10 , Åsa Magnusson 11 , Max Petzold 12 , Christina Bergh 13 , Anja Pinborg 6
Affiliation  

BACKGROUND In the decade following the introduction of ICSI, a higher prevalence of de novo chromosome abnormalities, in particular sex chromosome and autosomal structural abnormalities, as well as inherited abnormalities was described in children conceived by ICSI compared to both naturally conceived (NC) children and children conceived by standard IVF. The explanation for the observed increase in prevalence is not clear and has been suggested to reflect parental factors (e.g. age or sperm quality) or to be a result of the ICSI procedure itself. Over the years, the procedure, as well as the patient group, and indications for ICSI treatment have changed. OBJECTIVE AND RATIONALE The objective of this systematic review and meta-analysis was to assess the prevalence of chromosome abnormalities in ICSI pregnancies and children and to examine any potentially increased risk compared to standard IVF and NC. SEARCH METHODS Pubmed, Embase, Cochrane Libraries and Web of Science up to October 2020 were searched. Primary outcome measures were overall chromosome abnormalities and de novo abnormalities (including sex chromosome abnormalities and autosomal abnormalities). The secondary outcome was inherited abnormalities. We followed the PRISMA guidelines and relevant meta-analyses were performed. OUTCOMES The search included 4648 articles, out of which 27 met the inclusion criteria, and 19 were included in quantitative synthesis (meta-analyses). The prevalence of chromosome abnormalities varied considerably between studies, possibly explained by large differences in sample size and patient demographics. Only five studies were eligible for pooled analyses on adjusted data. All studies had a critical risk of bias. Results from pooled adjusted data showed no evidence of an increased risk of overall chromosome abnormalities when comparing ICSI to either standard IVF (aOR 0.75 (95% CI 0.41-1.38)) or NC (aOR 1.29 (95% CI 0.69-2.43)). In contrast, meta-analyses on unadjusted data showed an increased risk of overall chromosome abnormalities in ICSI compared to both standard IVF (OR 1.42 (95% CI 1.09-1.85)) and NC (OR 2.46 (95% CI 1.52-3.99)) and an increased risk of de novo abnormalities in ICSI compared to NC (OR 2.62 (95% CI 2.07-3.31)). Yet, based on a very low certainty of evidence, the conclusion remains, that no indication of an increased risk of chromosome abnormalities in ICSI offspring could be found. If an increased risk of chromosome abnormalities in selected ICSI offspring should exist, the absolute risk continues to be small. WIDER IMPLICATIONS This review provides an extensive overview of the existing evidence on the relationship between ICSI and chromosome abnormalities in the offspring. We highlight the need for well-designed large, prospective, controlled studies with systematic cytogenetic testing. Existing data are limited and, in many cases, marred by critical levels of bias.

中文翻译:

对ICSI和染色体异常之间的关联进行系统的回顾和荟萃分析。

背景技术在ICSI引入后的十年中,与自然受孕(NC)儿童和自然受孕儿童相比,ICSI受孕儿童的新生染色体异常(尤其是性染色体和常染色体结构异常以及遗传性异常)的患病率更高。由标准IVF孕育的孩子。所观察到的患病率增加的解释尚不清楚,并且被认为反映了父母因素(例如年龄或精子质量)或是ICSI程序本身的结果。多年来,该过程以及患者组以及ICSI治疗的适应症均发生了变化。目的和理由本系统评价和荟萃分析的目的是评估ICSI孕妇和儿童中染色体异常的患病率,并检查与标准IVF和NC相比可能增加的风险。搜索方法搜索截至2020年10月的Pubmed,Embase,Cochrane图书馆和Web of Science。主要的预后指标是总体染色体异常和从头异常(包括性染色体异常和常染色体异常)。次要结果是遗传异常。我们遵循了PRISMA指南,并进行了相关的荟萃分析。结果检索了4648篇文章,其中27篇符合纳入标准,其中19篇被纳入定量合成(元分析)。在研究之间,染色体异常的患病率差异很大,这可能是由于样本量和患者人口统计学的巨大差异所致。只有五项研究有资格对调整后的数据进行汇总分析。所有研究都有偏见的严重风险。将ICSI与标准IVF(aOR 0.75(95%CI 0.41-1.38))或NC(aOR 1.29(95%CI 0.69-2.43))进行比较时,来自汇总调整数据的结果显示没有证据显示总体染色体异常风险增加。相反,与标准IVF(OR 1.42(95%CI 1.09-1.85))和NC(OR 2.46(95%CI 1.52-3.99))相比,未经调整的数据进行荟萃分析显示,ICSI中总体染色体异常的风险增加。与NC(OR 2.62(95%CI 2.07-3.31))相比,ICSI中从头异常的风险增加。但是,基于证据的确定性很低,结论仍然存在,没有发现ICSI后代染色体异常风险增加的迹象。如果在选定的ICSI后代中存在染色体异常的风险增加,则绝对风险仍然很小。对儿童的影响本综述广泛地综述了有关ICSI与后代染色体异常之间关系的现有证据。我们强调需要精心设计的大型,前瞻性,对照研究,以及系统的细胞遗传学检测。现有数据是有限的,并且在许多情况下会受到严重偏见的损害。绝对风险仍然很小。对儿童的影响本综述广泛地综述了有关ICSI与后代染色体异常之间关系的现有证据。我们强调需要精心设计的大型,前瞻性,对照研究,以及系统的细胞遗传学检测。现有数据是有限的,并且在许多情况下会受到严重偏见的损害。绝对风险仍然很小。对儿童的影响本综述广泛地综述了有关ICSI与后代染色体异常之间关系的现有证据。我们强调需要精心设计的大型,前瞻性,对照研究,以及系统的细胞遗传学检测。现有数据是有限的,并且在许多情况下会受到严重偏见的损害。
更新日期:2021-05-06
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