Efficacy of intracytoplasmic sperm injection in women with non-male factor infertility: A systematic review and meta-analysis
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Review question / Objective: This meta-analysis aims to evaluate whether intracytoplasmic sperm injection (ICSI) improved reproductive outcomes for non-male factor infertility versus in vitro fertilization (IVF). Condition being studied: The use of ICSI has increased dramatically in recent years and is being applied for indications other than male factor infertility. However, despite its increased use, there is no clear evidence of the benefit of using ICSI over conventional IVF for non-male factor infertility. Eligibility criteria: Studies will be excluded if one of the following conditions is met: (1) unqualified male perm count and motility; (2) rescued ICSI; (3) non-RCTs of study design; (4) a significant amount of research data is missing or not available.Cite
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STUDY QUESTIONDoes ovarian hyperstimulation, the in vitro procedures required for in vitro fertilization (IVF)/ intracytoplasmic sperm injection or the combination of both, affect the neurological outcome of 4-year-old singletons?
Controlled ovarian hyperstimulation
Ovarian hyperstimulation syndrome
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Abstract Study question What is the risk level and potential etiology of preterm birth (PTB) in singleton pregnancies from in-vitro fertilization (IVF) or intra-cytoplasmic injection (ICSI)? Summary answer Singleton pregnancies from IVF/ICSI have, on average, double the risk of PTB compared to natural conceptions, with a higher risk for iatrogenic than spontaneous PTB. What is known already IVF/ICSI pregnancies are associated with a higher PTB risk, with a predominant effect mediated by the effect of multiples and a poor understanding of underlying etiology, particularly in singletons. According to the European IVF Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE), about 16% of singleton conceived through IVF/ICSI were born preterm in 2019. Considering the global a shift towards single embryo transfers (ETs), it becomes crucial to precisely determine and convey the PTB risk specific to singleton pregnancies conceived through IVF/ICSI, collecting all available evidence on supposed PTB etiology. Study design, size, duration A comprehensive search in major online databases was conducted up to December 31, 2023. Eligible studies were systematic reviews with quantitative data. The primary aim was to quantify PTB risk in singletons conceived by IVF/ICSI compared to natural pregnancies. Secondary objectives included assessing very preterm birth (VPTB) risk and exploring PTB’s etiology, phenotype, and initiation. PTB and VPTB were defined by the World Health Organization as delivery before 37 or 32 weeks, respectively. Participants/materials, setting, methods Random-effects meta-analysis models were used for pooling effect measures. Estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Information available on etiology, phenotype, initiation of PTB and relevant moderators was extracted and employed for subgroup analyses. The extent of overlap in the original studies was measured using the Corrected Covered Area (CCA) assessment. The quality of the included reviews was evaluated with the AMSTAR 2 tool and quality of evidence by GRADE. Main results and the role of chance Twelve meta-analyses with a total of 16,522,917 pregnancies were included. IVF/ICSI singletons showed a significantly higher risk of PTB compared to natural conception (PTB ˂37 weeks: OR: 1.72, 95% CI: 1.57-1.89). The pooled risk estimate was higher for births below 32 weeks (VPTB <32 weeks: OR: 2.19, 95%CI: 1.82-2.64). Influential analysis reinforced the strength of this association. Subgroup analyses investigating supposed etiology revealed a comparable risk magnitude for spontaneous PTB (OR 1.79, 95% CI:1.56-2.04) and a greater risk for iatrogenic PTB (OR: 2.28, 95%CI: 1.72–3.02). PTB risk was consistent in the subgroup of conventional IVF (OR: 1.95, 95% CI: 1.76-2.15) and higher in the subgroup of fresh-only ETs (OR: 1.79, 95% CI: 1.55-2.07) compared to frozen-thawed ETs (OR: 1.39, 95%CI: 1.34-1.43). CCA assessment showed minimal study overlap (13%). The quality of the evidence by GRADE assessment was judged as low to very low. Limitations, reasons for caution The methodological quality of the included reviews, as rated by AMSTAR 2, was judged as low to very low. Most included studies lacked granular data on IVF/ICSI indications and on specific PTB etiology, phenotypes, or initiation. Wider implications of the findings The risk of PTB is about double in IVF/ICSI singleton pregnancies compared to naturally conceived, with paucity of available data on PTB aetiology, phenotype, or initiation. The greater risk increase involves iatrogenic PTB from fresh ET and VPTB, likely due to placental aetiology. Trial registration number PROSPERO ID: CRD42023411418
Singleton
Live birth
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Spontaneous conception
Assisted Reproductive Technology
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Background Techniques for embryo transfer (ET) are being developed, optimized, and standardized to provide the best outcomes.This includes methods to reduce the risk of embryo loss following ET. Objectives To systematically locate, analyse, and review the best available evidence regarding the effectiveness of post‐ET techniques for women undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Search methods We searched electronic databases; reference lists of primary studies, review articles, and relevant publications; and conference abstracts. No language restrictions were applied. Selection criteria Screening and selection of 2436 possible trial citations were performed independently by two review authors. Four prospective, truly randomised trials met the inclusion criteria. The trials compared two competing post ET interventions or an intervention versus no treatment in women undergoing IVF and ICSI. Data collection and analysis Two review authors independently collected data and assessed risk of bias using a standardized data extraction form. Individual outcome data were extracted to support an intention‐to‐treat analysis. Main results The primary outcome, live birth rate, was not reported in any of the included trials. The ongoing pregnancy rate was only available for one trial that compared immediate ambulation with 30 minute bed rest, with no evidence of an effect with bed rest (OR 1.00; 95% CI 0.54 to 1.85). Secondary outcomes were sporadically reported with the exception of clinical pregnancy rate, which was reported in all of the included trials. There was no significant difference between less bed rest and more rest (OR 1.13; 95% CI 0.77 to 1.67). Nor was there any significant difference between the use of a fibrin sealant and control (OR 0.98; 95% CI 0.54 to 1.78). Even so, there was a significantly higher probability of pregnancy following mechanical closure of the cervix compared with no intervention (OR 1.92; 95% CI 1.40 to 2.63). The risk of bias of the included studies was variable. The reporting of a proper method of randomisation and allocation concealment was demonstrated in the majority of trials, while only one trial was reported to be blinded. Authors' conclusions There is insufficient evidence to support a certain amount of time for women to remain recumbent following ET, or to support the use of fibrin sealants. Finally, there is limited evidence to support the use of mechanical closure of the cervical canal following ET. Further well‐designed and powered studies are required to determine the true effect, if any, of these and other post ET techniques for women undergoing IVF and ICSI.
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The objective of this meta-analysis is to assess the impact of LH supplementation in women undergoing in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) with gonadotropin releasing hormone (GnRH) antagonist protocol. No significant difference in outcomes between LH supplementation and r-FSH alone in women undergoing IVF/ICSI with GnRH antagonist protocol is currently present, and further studies are necessary for more solid conclusions on pregnancy likelihood to be drawn.
Gonadotropin-releasing hormone antagonist
Hormone antagonist
Gonadotropin
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Objective To evaluate the clinical use of intracytoplasmic sperm injection when fertilization cycles in vitro failed. Methods Reinsemination by using of intracytoplasmic sperm injection was carried out 24 h after oocytes retrieval in the failed fertilization cycles in vitro. Results A total of 127 one-day-old Mu oocytes from 14 failed fertilization cycles in vitro were subjected to intracyto- plasmic sperm injection. Among them, 105 were survived(82. 7%), 15 polyploidic (11. 8%), and 71 (55. 9%) fertilized normally, of which, 61(85.9%) cleaved. Thirty-two embryos were trans- ferred to 13 patients. One patient (7.7%) conceived after ET. Conclusions Intracytoplasmic sperm injection can be used when fertilization cycles in vitro failed for either diagnostic or thera- peutic purpose, but the pregnancy rates seems not high.
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Objectives Pregnancy outcomes of different ovarian stimulation protocols for in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) in patients with adenomyosis are not explicit. This meta-analysis aimed to systematically evaluate the effects of different IVF/ICSI protocols on pregnancy outcomes. Design Meta-analysis. Data sources PubMed, Web of Science and Cochrane library were searched up to October 2023. Eligibility criteria Comparative studies on IVF/ICSI outcomes in the adenomyosis population were eligible. Studies on preimplantation genetic testing, reviews, case reports and animal experiments were excluded. Data extraction and synthesis Valid information was extracted by two independent authors according to a standard data format. All analyses were conducted using Review Manager (RevMan, V.5.3). Results Compared with the non-adenomyosis population, adenomyosis was responsible for a 26% reduction in clinical pregnancy rate (CPR; 42.47% vs 55.89%, OR: 0.74, 95% CI: 0.66 to 0.82, p<0.00001), a 35% reduction in live birth rate (LBR; 30.72% vs 47.77%, OR: 0.65, 95% CI: 0.58 to 0.73, p<0.00001) and a 1.9-fold increase in miscarriage rate (MR; 27.82% vs 13.9%, OR: 1.90, 95% CI: 1.56 to 2.31, p<0.00001). Subgroup analysis suggested that, in fresh embryo transfer (ET) cycles, the CPR (34.4% vs 58.25%) in the long/short/antagonist protocol group was poorer than that in the ultralong protocol group. In frozen ET (FET) cycles, there were no statistical differences in CPR ((GnRHa+FET) AM(adenomyosis) vs non-AM: 51.32% vs 43.48%, p=0.31; (non-GnRHa+FET) AM vs non-AM: 50.25% vs 60.10%, p=0.82), MR ((GnRHa+FET) AM vs non-AM:12.82% vs 12.50%, p=0.97; (non-GnRHa+FET) AM vs non-AM: 30.5% vs 15.54%, p=0.15) and LBR ((GnRHa+FET) AM vs non-AM:44.74% vs 36.96%, p=0.31; (non-GnRHa+FET) AM vs non-AM: 34.42% vs 50.25%, p=0.28). The MR in the adenomyosis group was high in the fresh ET and FET cycles. Conclusions FET might be a better choice for women with adenomyosis, especially those pretreated with GnRHa. In fresh ET cycles, pregnancy outcomes of the long/short/antagonist protocols were poorer than those of the ultralong protocol. Trial registration number CRD42022340743.
Adenomyosis
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Gonadotropin
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the relative effectiveness of post‐embryo transfer techniques on women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
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