Lauren N C Johnson1, Isaac E Sasson, Mary D Sammel, Anuja Dokras. 1. Reproductive Endocrinology and Infertility, Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. lauren.johnson2@uphs.upenn.edu
Abstract
OBJECTIVE: To determine if intracytoplasmic sperm injection (ICSI), compared with conventional insemination, improves fertilization rates and prevents total failed fertilization (TFF) in couples with unexplained infertility. DESIGN: Systematic review and meta-analysis. SETTING: IVF centers. PATIENT(S): Couples with well-defined unexplained infertility undergoing IVF. INTERVENTION(S): A systematic review was performed by searching Medline and Embase for 1992-2012. Studies in which sibling oocytes were randomly split between conventional insemination and ICSI were included. A random effects model was utilized for the meta-analysis. Meta-analysis of Observational Studies in Epidemiology guidelines were applied. MAIN OUTCOME MEASURE(S): Fertilization rate and TFF rate by insemination method. RESULT(S): Eleven studies with a total of 901 couples (female age range 30-35 years) with 11,767 sibling oocytes were included in the meta-analysis. The pooled relative risk (RR) of a mature oocyte fertilizing was higher with ICSI than with conventional insemination (RR 1.49, 95% confidence interval [CI] 1.35-1.65.) The pooled RR of fertilization per allocated oocyte (before randomization) was higher with ICSI than with conventional insemination (RR 1.27, 95% CI 1.02-1.58; n = 5 studies.) The pooled RR of TFF was significantly higher with conventional insemination than with ICSI (RR 8.22, 95% CI 4.44-15.23). The number of subjects needed to treat with ICSI to prevent one case of TFF was five. CONCLUSION(S): This meta-analysis favors the use of ICSI to increase fertilization rates and decrease the risk of TFF in couples with well-defined unexplained infertility. Further studies are needed to determine the impact on clinical pregnancy and live birth rate.
OBJECTIVE: To determine if intracytoplasmic sperm injection (ICSI), compared with conventional insemination, improves fertilization rates and prevents total failed fertilization (TFF) in couples with unexplained infertility. DESIGN: Systematic review and meta-analysis. SETTING: IVF centers. PATIENT(S): Couples with well-defined unexplained infertility undergoing IVF. INTERVENTION(S): A systematic review was performed by searching Medline and Embase for 1992-2012. Studies in which sibling oocytes were randomly split between conventional insemination and ICSI were included. A random effects model was utilized for the meta-analysis. Meta-analysis of Observational Studies in Epidemiology guidelines were applied. MAIN OUTCOME MEASURE(S): Fertilization rate and TFF rate by insemination method. RESULT(S): Eleven studies with a total of 901 couples (female age range 30-35 years) with 11,767 sibling oocytes were included in the meta-analysis. The pooled relative risk (RR) of a mature oocyte fertilizing was higher with ICSI than with conventional insemination (RR 1.49, 95% confidence interval [CI] 1.35-1.65.) The pooled RR of fertilization per allocated oocyte (before randomization) was higher with ICSI than with conventional insemination (RR 1.27, 95% CI 1.02-1.58; n = 5 studies.) The pooled RR of TFF was significantly higher with conventional insemination than with ICSI (RR 8.22, 95% CI 4.44-15.23). The number of subjects needed to treat with ICSI to prevent one case of TFF was five. CONCLUSION(S): This meta-analysis favors the use of ICSI to increase fertilization rates and decrease the risk of TFF in couples with well-defined unexplained infertility. Further studies are needed to determine the impact on clinical pregnancy and live birth rate.
Authors: Erica T Y Leung; Cheuk-Lun Lee; Xinyi Tian; Kevin K W Lam; Raymond H W Li; Ernest H Y Ng; William S B Yeung; Philip C N Chiu Journal: Nat Rev Urol Date: 2021-11-05 Impact factor: 14.432
Authors: Ioannis A Sfontouris; Efstratios M Kolibianakis; George T Lainas; Ram Navaratnarajah; Basil C Tarlatzis; Trifon G Lainas Journal: J Assist Reprod Genet Date: 2015-03-11 Impact factor: 3.412