形态选择性卵细胞胞质内单精子注射对比卵细胞胞质内单精子注射治疗男性因素不育症的Meta分析

IMSI versus ICSI for male factor infertility: A meta-analysis

目的:评价形态选择性卵细胞胞质内单精子注射(IMSI)对比卵细胞胞质内单精子注射(ICSI)治疗男性因素不育症的效果和安全性。方法:采用Cochrane系统评价方法,检索MEDLINE、EMBASE、CENTRAL、Clinical Trials.gov和Sino Med数据库,检索时限为1992年至2017年7月,并手工检索相关参考文献,纳入比较IMSI和ICSI的随机对照试验(RCT)。应用Rev Man 5.3软件进行Meta分析。由于单纯男性因素和合并男性因素的不育症患者具有明显的临床异质性,故行亚组分析。结果:检索到文献280篇,纳入8个RCT,合计1 741个周期(IMSI=842,ICSI=899)。在单纯男性因素亚组,无证据证明IMSI周期和ICSI周期的活产率具有差异[RR=1.31,95%CI(0.68,2.51),1个RCT,77个周期,极低质量证据];IMSI能提高临床妊娠率[RR=1.46,95%CI(1.02,2.07),4个RCT,813个周期,低质量证据]。在合并男性因素亚组,均无证据证明IMSI周期和ICSI周期的活产率[RR=0.88,95%CI(0.60,1.31),1个RCT,255个周期,低质量证据]和临床妊娠率[RR=1.03,95%CI(0.86,1.23),3个RCT,851个周期,中等质量证据]具有差异。结论:尽管IMSI能提高单纯男性因素不育症患者体外受精周期的临床妊娠率,但证据质量等级较低,尚不足以支持将IMSI常规应用于该类患者。

Objective： To evaluate the efficacy and safety of intracytoplasmic morphologically selected sperm injection （IMSI） versus intraeytoplasmie sperm injection （ICSI） in in vitro fertilization （IVF） for couples with male factor infertility. Methods： Using the Cochrane system evaluation method, we searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials. gov, and SiuoMed and manu- ally searched the reference lists of the included studies and relevant reviews for randomized controlled trials （RCT） comparing ICSI and IMSI published from 1992 to July 2017. We performed a meta-analysis on the included literature with the RevMan 5.3 software and subgroup analyses due to the prominent clinical heterogeneity of the atients. Results： Of the 280 articles retrieved, 8 RCTs wereincluded, involving 1 741 IVF cycles （842 cycles of IMSI versus 899 cycles of ICSI）. There was no evidence for any significant differ- ence between IMSI and ICSI in the live birth rate in the subgroup of infertility induced by pure male factors （RR = 1.31, 95% CI： 0.68 - 2.51 ; very low quality evidence from 1 RCT with 77 cycles ） but an association of IMSI with an increased clinical pregnancy rate （ RR = 1.46, 95% CI ： 1.02 - 2.07 ; low quality evidence from 4 RCTs with 813 cycles）, nor was there any evidence for that in the live birth rate （ RR = 0.88, 95% CI： 0.60 - 1.31 ; low quality evidence from 1 RCT with 255 cycles） or clinical pregnancy rate （ RR = 1.03,95% CI： 0.86 - 1.23 ; moderate quality evidence from 3 RCTs with 851 cycles） in the subgroup of infertility caused by accompanying male factors. Conclusion ： The evidence is of low quality for the association of IMSI with an increased rate of clinical pregnancy and is not sufficient to support the routine use of IMSI in IVF for male factor infertility.