与细胞体内精子注射相关的使用趋势和生殖结果
Sheree L Boulet1, Akanksha Mehta2, Dmitry M Kissin3
1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA
|January 21, 2015
概括
内细胞质精子注射 (ICSI) 的使用在体外受精 (IVF) 周期中显著增加,即使没有男性因子不孕. 这项研究发现,与传统试管婴儿相比,ICSI并没有改善生殖结果.
科学领域:
- 生殖医学 生殖医学
- 不孕症治疗 不孕症治疗
- 辅助生殖技术 辅助生殖技术
背景情况:
- 内细胞质精子注射 (ICSI) 越来越多地用于体外受精 (IVF) 周期.
- 在男性不严重因子不育病例中,支持ICSI比常规试管婴儿的好处的证据有限.
- 评估国家趋势和结果对于理解ICSI的作用至关重要.
研究的目的:
- 评估1996-2012年新鲜试管婴儿周期ICSI使用的国家趋势.
- 为了比较ICSI与常规试管婴儿的生殖结果.
- 根据男性因子不育的存在或不存在来分析结果.
主要方法:
- 使用美国国家辅助生殖技术监测系统数据 (1996-2012) 进行的回顾性队列研究.
- 分析ICSI在各种不孕症症状中的使用趋势.
- 在新生周期 (2008-2012) 中,ICSI和常规试管婴儿之间的生殖结果 (植入,活产,多胎出生率) 的比较.
主要成果:
- 在新的试管婴儿周期中,ICSI的使用率从36.4% (1996年) 增加到76.2% (2012年),在没有男性因子不孕症的周期中增长最为显著.
- 对于男性因子不孕周期,ICSI的使用率从76.3%增加到93.3%.
- 在没有男性因子不孕症的周期中,ICSI的使用率从15.4%增加到66.9%.
- 在2008-2012年期间,ICSI与男性因子不孕周期 (30.9%与34.2%) 中的多胎出生率较低有关.
- 在没有男性因子不育的周期中,ICSI的使用与传统IVF相比,与较低的植入率 (23.0%vs25.2%),活产率 (36.5%vs39.2%) 和多个活产率 (30.1%vs31.0%) 相关联.
结论:
- 在美国新鲜的试管婴儿周期中,ICSI的使用量急剧增加,特别是在没有男性因子不孕症的情况下.
- 与传统的试管婴儿相比,ICSI没有证明受精后生殖结果有所改善,无论男性因子不孕状态如何.
- 这些发现表明,需要重新评估当前生育实践中ICSI的适用性.
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