{"title":"我们是否应该向所有不明原因不孕症夫妇提供卵胞浆内单精子注射：一项队列研究。","authors":"Neeta Singh, Neena Malhotra, Reeta Mahey, Supriya Kumari, Monika Saini, Nisha","doi":"10.4103/jhrs.jhrs_157_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In unexplained infertility (UI), the use of intracytoplasmic sperm injection (ICSI) has been increased to prevent total fertilisation failure (TFF). However, there is little evidence to support improved clinical outcomes.</p><p><strong>Aim: </strong>The aim of the study was to assess whether ICSI improves the outcomes compared to conventional <i>in vitro</i> fertilisation (IVF) in UI.</p><p><strong>Settings and design: </strong>A retrospective cohort study in a tertiary centre.</p><p><strong>Materials and methods: </strong>Patients were divided into two groups. Group A in which ICSI-cycles were performed and Group B in which IVF-cycles were performed. All UI couples with females aged between 21 and 38 years who underwent the first long GnRH-agonist or GnRH-antagonist protocol stimulation cycle followed by fresh embryo transfer were included. UI couples who needed rescue-ICSI, donor-recipient cycles and pre-implantation genetic diagnosis were excluded. Outcomes were fertilisation rate, TFF, good-quality day 3 embryo, implantation rate, miscarriage rate and clinical pregnancy rate.</p><p><strong>Statistical analysis used: </strong>STATA 18.0 software (Stata Corp, TX, USA) was used.</p><p><strong>Results: </strong>A total of 511 UI patients were included out of which 182 underwent ICSI and 310 underwent IVF cycles. Baseline characteristics were similar in both groups. The mean percentage fertilisation rate was comparable in the ICSI and IVF groups (67.18 ± 22.61 vs. 66.93 ± 26.66, <i>P</i> = 0.92, respectively). TFF was lower in the ICSI group compared to the IVF group (2.7% vs. 5.8%, <i>P</i> = 0.12). The mean number of good-quality embryo development rate on day 3 was similar between the ICSI and IVF groups (<i>P</i> = 0.93). Although implantation and clinical pregnancy rates were higher in the IVF group compared to the ICSI group with <i>P</i> > 0.05, these differences were not statistically significant.</p><p><strong>Conclusion: </strong>The study reported reduced TFF in the ICSI group in comparison to the IVF group but was not statistically significant with comparable clinical outcomes.</p>","PeriodicalId":15975,"journal":{"name":"Journal of Human Reproductive Sciences","volume":"18 1","pages":"9-15"},"PeriodicalIF":1.1000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057842/pdf/","citationCount":"0","resultStr":"{\"title\":\"Should We Be Offering Intracytoplasmic Sperm Injection to All Couples with Unexplained Infertility: A Cohort Study.\",\"authors\":\"Neeta Singh, Neena Malhotra, Reeta Mahey, Supriya Kumari, Monika Saini, Nisha\",\"doi\":\"10.4103/jhrs.jhrs_157_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In unexplained infertility (UI), the use of intracytoplasmic sperm injection (ICSI) has been increased to prevent total fertilisation failure (TFF). However, there is little evidence to support improved clinical outcomes.</p><p><strong>Aim: </strong>The aim of the study was to assess whether ICSI improves the outcomes compared to conventional <i>in vitro</i> fertilisation (IVF) in UI.</p><p><strong>Settings and design: </strong>A retrospective cohort study in a tertiary centre.</p><p><strong>Materials and methods: </strong>Patients were divided into two groups. Group A in which ICSI-cycles were performed and Group B in which IVF-cycles were performed. All UI couples with females aged between 21 and 38 years who underwent the first long GnRH-agonist or GnRH-antagonist protocol stimulation cycle followed by fresh embryo transfer were included. UI couples who needed rescue-ICSI, donor-recipient cycles and pre-implantation genetic diagnosis were excluded. Outcomes were fertilisation rate, TFF, good-quality day 3 embryo, implantation rate, miscarriage rate and clinical pregnancy rate.</p><p><strong>Statistical analysis used: </strong>STATA 18.0 software (Stata Corp, TX, USA) was used.</p><p><strong>Results: </strong>A total of 511 UI patients were included out of which 182 underwent ICSI and 310 underwent IVF cycles. Baseline characteristics were similar in both groups. The mean percentage fertilisation rate was comparable in the ICSI and IVF groups (67.18 ± 22.61 vs. 66.93 ± 26.66, <i>P</i> = 0.92, respectively). TFF was lower in the ICSI group compared to the IVF group (2.7% vs. 5.8%, <i>P</i> = 0.12). The mean number of good-quality embryo development rate on day 3 was similar between the ICSI and IVF groups (<i>P</i> = 0.93). Although implantation and clinical pregnancy rates were higher in the IVF group compared to the ICSI group with <i>P</i> > 0.05, these differences were not statistically significant.</p><p><strong>Conclusion: </strong>The study reported reduced TFF in the ICSI group in comparison to the IVF group but was not statistically significant with comparable clinical outcomes.</p>\",\"PeriodicalId\":15975,\"journal\":{\"name\":\"Journal of Human Reproductive Sciences\",\"volume\":\"18 1\",\"pages\":\"9-15\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057842/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Human Reproductive Sciences\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/jhrs.jhrs_157_24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/29 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Human Reproductive Sciences","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/jhrs.jhrs_157_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/29 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
背景：在不明原因不孕症（UI）中，使用卵胞浆内单精子注射（ICSI）已经增加，以防止完全受精失败（TFF）。然而，几乎没有证据支持改善临床结果。目的：本研究的目的是评估与传统体外受精（IVF）相比，ICSI是否能改善UI患者的预后。背景和设计：在高等教育中心进行回顾性队列研究。材料与方法：将患者分为两组。A组行icsi周期，B组行ivf周期。所有女性年龄在21岁至38岁之间的UI夫妇均接受了第一个长gnrh激动剂或gnrh拮抗剂方案刺激周期，然后进行新鲜胚胎移植。需要挽救- icsi，供体-受体周期和植入前遗传学诊断的UI夫妇被排除在外。观察受精率、TFF、第3天胚胎质量、着床率、流产率和临床妊娠率。统计分析采用STATA 18.0软件（STATA Corp， TX， USA）。结果：共纳入511例UI患者，其中ICSI 182例，IVF 310例。两组的基线特征相似。ICSI组和IVF组的平均受精率相当（67.18±22.61 vs 66.93±26.66,P = 0.92）。ICSI组TFF低于IVF组（2.7% vs. 5.8%, P = 0.12）。ICSI组和IVF组第3天的平均优质胚胎数发育率相似（P = 0.93）。虽然IVF组的着床率和临床妊娠率高于ICSI组（P < 0.05），但差异无统计学意义。结论：该研究报告了ICSI组与IVF组相比TFF降低，但临床结果可比无统计学意义。
Should We Be Offering Intracytoplasmic Sperm Injection to All Couples with Unexplained Infertility: A Cohort Study.
Background: In unexplained infertility (UI), the use of intracytoplasmic sperm injection (ICSI) has been increased to prevent total fertilisation failure (TFF). However, there is little evidence to support improved clinical outcomes.
Aim: The aim of the study was to assess whether ICSI improves the outcomes compared to conventional in vitro fertilisation (IVF) in UI.
Settings and design: A retrospective cohort study in a tertiary centre.
Materials and methods: Patients were divided into two groups. Group A in which ICSI-cycles were performed and Group B in which IVF-cycles were performed. All UI couples with females aged between 21 and 38 years who underwent the first long GnRH-agonist or GnRH-antagonist protocol stimulation cycle followed by fresh embryo transfer were included. UI couples who needed rescue-ICSI, donor-recipient cycles and pre-implantation genetic diagnosis were excluded. Outcomes were fertilisation rate, TFF, good-quality day 3 embryo, implantation rate, miscarriage rate and clinical pregnancy rate.
Statistical analysis used: STATA 18.0 software (Stata Corp, TX, USA) was used.
Results: A total of 511 UI patients were included out of which 182 underwent ICSI and 310 underwent IVF cycles. Baseline characteristics were similar in both groups. The mean percentage fertilisation rate was comparable in the ICSI and IVF groups (67.18 ± 22.61 vs. 66.93 ± 26.66, P = 0.92, respectively). TFF was lower in the ICSI group compared to the IVF group (2.7% vs. 5.8%, P = 0.12). The mean number of good-quality embryo development rate on day 3 was similar between the ICSI and IVF groups (P = 0.93). Although implantation and clinical pregnancy rates were higher in the IVF group compared to the ICSI group with P > 0.05, these differences were not statistically significant.
Conclusion: The study reported reduced TFF in the ICSI group in comparison to the IVF group but was not statistically significant with comparable clinical outcomes.
期刊介绍：
The Journal of Human Reproductive Sciences (JHRS) (ISSN:0974-1208) a Quarterly peer-reviewed international journal is being launched in January 2008 under the auspices of Indian Society of Assisted Reproduction. The journal will cover all aspects human reproduction including Andrology, Assisted conception, Endocrinology, Physiology and Pathology, Implantation, Preimplantation Diagnosis, Preimplantation Genetic Diagnosis, Embryology as well as Ethical, Legal and Social issues. The journal will publish peer-reviewed original research papers, case reports, systematic reviews, meta-analysis, and debates.
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