内细胞质精子注射与常规体外受精在无法解释的不孕症
Aya Iwamoto1, Karen M Summers1, Amy Sparks1
1Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
F&S reports
|October 9, 2024
概括
与传统体外受精 (cIVF) 相比,用于无法解释的不孕症的常规细胞体内精子注射 (ICSI) 在累积活产率方面没有显著的好处. ICSI造成更高的成本,但没有改善活产子的结果,因此对这个患者群体来说是不合理的.
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:
- 无法解释的不孕症影响了大量寻求生育治疗的夫妇.
- 内细胞质精子注射 (ICSI) 和常规体外受精 (cIVF) 是主要的辅助生殖技术.
- 在无法解释的不孕症中,ICSI与cIVF的比较有效性和成本效益需要进一步阐明.
研究的目的:
- 为了比较累积活产率 (CLBR) 和ICSI与cIVF的成本效益.
- 评估二次结果,包括受精率,流产率和胚胎利用率.
- 评估植入前遗传测试对形积分病 (PGT-A) 对这些比较的影响.
主要方法:
- 使用来自助孕生殖技术协会 (SART) 临床结果报告系统的数据进行回顾性队列研究.
- 包括在2021年12月之前进行链接胚胎移植的未解释不育症患者进行首次自身检索周期 (2017年1月至2019年12月) 的患者.
- 结果根据患者年龄,BMI,检索卵细胞,随访时间和临床特定的ICSI利用率进行调整.
主要成果:
- 在ICSI和cIVF之间没有观察到CLBR的显著差异,无论是带有PGT-A还是没有PGT-A.
- 没有PGT-A的ICSI周期显示出更高的流产率,而与PGT-A的流产率相似.
- ICSI的结果是,每次取出的卵子细胞中,每次取出的两个核前卵子细胞 (2PN) 的比率较低,而胚胎移植或冷保存率每次2PN没有显著差异.
- 与ICSI (1.1%) 相比,cIVF (4%) 的总受精失败率更高.
- 与cIVF相比,ICSI产生了相当大的额外成本,估计每年超过1100万美元,没有PGT-A,每年超过900万美元,有PGT-A.
结论:
- 目前的证据不支持ICSI在不明原因不孕症患者的常规使用.
- 与ICSI相关的额外成本并没有转化为改善累积活产率.
- 传统的试管婴儿仍然是无法解释不育症的成本有效的初级治疗选择.
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