在没有严重男性因子不孕症的患者中,试管婴儿与ICSI相比:一种随机临床试验
Sine Berntsen1, Anne Zedeler1, Bugge Nøhr2
1Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Nature medicine
|April 11, 2025
概括
传统的体外受精 (c-IVF) 对于没有严重男性因子不孕症的患者,与细胞内精子注射 (ICSI) 一样有效. 这项研究发现c-IVF提供了类似的累积活产率,支持它作为首选的第一线治疗.
科学领域:
- 生殖医学 生殖医学
- 辅助生殖技术 (ART) 是一种辅助生殖技术.
背景情况:
- 内细胞质精子注射 (ICSI) 是严重的男性因子不孕症的标准.
- 在没有严重男性因子不孕症的患者中,ICSI与传统体外受精 (c-IVF) 的疗效仍在争论中.
- 在正常或不严重降低精子质量的情况下,常规ICSI的使用缺乏强有力的证据.
研究的目的:
- 为了比较ICSI和c-IVF之间的累积活产率 (CLBR).
- 评估ICSI与c-IVF在没有严重男性因子不孕症的患者中的有效性.
- 为辅助生殖中第一线受精技术提供基于证据的建议.
主要方法:
- 一个开放的,多中心的随机对照试验 (INVICSI研究).
- 接受第一次试管婴儿周期的824名女性被随机分配到ICSI (n=414) 或c-IVF (n=410).
- 数据是在2019年11月至2022年12月期间在丹麦六家公共生育诊所收集的.
主要成果:
- 在ICSI中,CLBR为43.2%,在c-IVF中为47.3%.
- 对CLBR的风险比为0.91 (95% CI,0.79-1.06),表明没有显著差异.
- 在这组患者中,与c-IVF相比,ICSI没有证明CLBR有所改善.
结论:
- 传统的体外受精 (c-IVF) 是适合于正常或不严重降低精子质量的患者的第一线治疗方法.
- 内细胞质精子注射 (ICSI) 应保留给严重的男性因子不孕症病例.
- 这项研究支持c-IVF而不是ICSI,当严重的男性因子不育缺席时,优化了生育治疗中的资源配置.
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