Impact of intracytoplasmic sperm injection in women with non-male factor infertility: A systematic review and meta-analysis

Abstract

ObjectiveThe purpose of this study is to determine whether intracytoplasmic sperm injection (ICSI) is beneficial in patients with non-male factor infertility.MethodsThis systematic review and meta-analysis included articles from inception to May 2022. Published studies of non-male factor infertile women undergoing ICSI or in vitro fertilization (IVF) included in PubMed, Embase, web of science, Wanfang Database, and CNKI were searched by computer, without language restrictions. A random-effect model was applied to calculate the risk ratios (RRs) and their 95% confidence intervals (CIs). Letters, case reports, and review articles including meta-analyses and expert opinions were excluded. The primary endpoints were laboratory outcomes and pregnancy outcomes. The Secondary endpoints were neonatal outcomes.ResultsSix randomized controlled studies and 20 retrospective cohort studies met the inclusion criteria. In meta-analytic forest plots, compared with IVF, those who received ICSI treatment were not different in fertilization rate (RR = 0.99, 95% CI [0.90–1.09], P = 0.88), total fertilization failure rate (RR = 1.30, 95% CI [1.17–1.45], P < 0.00001), and good quality embryo rate (RR = 0.94, 95% CI [ 0.86–1.02], P = 0.15), clinical pregnancy rate (RR = 0.84, 95% CI [0.70–1.01], P = 0.06), live birth rate (RR = 0.89, 95% CI [0.77–1.03], P = 0.13), miscarriage rate (RR = 1.06, 95% CI [0.78–1.43], P = 0.71), preterm neonatal delivery rate (RR = 0.92, 95% CI [0.67–1.26], P = 0.61), and low neonatal weight rate (RR = 1.13, 95% CI [0.80–1.61], P = 0.48). However, the implantation rate of IVF was better than ICSI (RR = 0.77, 95% CI [0.64–0.93], P = 0.005). In the subgroup analysis of the live birth rate of fresh embryo transfer, IVF performed in those ≥35 years had a higher live birth rate (RR = 0.82, 95% CI [0.78–0.83], P < 0.001).ConclusionThe findings of this study indicate that ICSI is not superior to IVF in the treatment of infertility related to non-male factors. In order to confirm this result, more high-quality clinical studies are needed.

Construction of the machine learning-based live birth prediction models for the first in vitro fertilization pregnant women

“…In practice, the freeze-all strategy can reduce the risk of ovarian hyperstimulation syndrome (OHSS) in the ovarian stimulation cycle by avoiding pregnancy and obtaining better results [ 39 ]. However, the results of a previous meta-analysis showed no differences in fertilization rate, total fertilization failure rate, good embryo quality rate, fresh embryo implantation clinical pregnancy rate, fresh embryo transfer live birth rate, miscarriage rate, neonatal preterm birth rate and neonatal low birth weight rate in those treated with ICSI compared with IVF [ 40 ]. The relationship between the fertilization method and live birth needs further clarification.…”

The effects of endometrial thickness on outcomes of pregnancy following embryo transfer: A retrospective cohort

“…We used controlled ovary stimulation for ICSI and gonadotropin-releasing hormone agonists or antagonists to prevent premature ovulation. Follicle-stimulating hormone injections were administered until the follicular diameter of 18 mm was reached (Huang et al, 2022;Ribeiro & Sousa, 2023;Rodriguez-Wallberg et al, 2022). A 10000-unit human chorionic gonadotropin (hCG) was injected and after 36 hours the oocytes were retrieved using a transvaginal ultrasound probe to guide a specialized needle through the vaginal wall and into the ovaries and were fertilized with husband sperms.…”

Efficacy of intracytoplasmic sperm injection in women with non‐male factor infertility: A systematic review and meta‐analysis

“…[10][11][12] Further, the applicability of the evidence is also limited by the methodological quality of the reviews, for instance, pooling estimates from randomized and observational studies, introducing selection bias and reducing credibility, and relying on laboratory surrogate outcomes rather than patient important outcomes to draw conclusions. [9][10][11][12] Recently, several new randomized controlled trials (RCTs) are accessible and yielded more reliable ICSI results. [13][14][15][16] Therefore, it is necessary to conduct a new systematic review and meta-analysis of RCTs to avoid the above limitations in existing reviews to provide robust evidence clarifying the efficacy of ICSI in non-male factor infertility couples.…”

“…9 In contrast, other reviews suggested that ICSI offers no obvious advantage regarding FR and CPR. [10][11][12] Further, the applicability of the evidence is also limited by the methodological quality of the reviews, for instance, pooling estimates from randomized and observational studies, introducing selection bias and reducing credibility, and relying on laboratory surrogate outcomes rather than patient important outcomes to draw conclusions. [9][10][11][12] Recently, several new randomized controlled trials (RCTs) are accessible and yielded more reliable ICSI results.…”

“…analyzed 11 studies involving 901 couples and found that ICSI increased FR and decreased the risk of TFF in couples with unexplained non‐male infertility 9 . In contrast, other reviews suggested that ICSI offers no obvious advantage regarding FR and CPR 10–12 . Further, the applicability of the evidence is also limited by the methodological quality of the reviews, for instance, pooling estimates from randomized and observational studies, introducing selection bias and reducing credibility, and relying on laboratory surrogate outcomes rather than patient important outcomes to draw conclusions 9–12 …”