囊胚冷凍前使用輔助孵化造成囊胚提早shrinking  雖可提高囊胚存活率&PR
但無法有效提高IR&活產率

Hum Fertil (Camb). 2020 Jan 24:1-9. doi: 10.1080/14647273.2019.1701205. [Epub ahead of print]

Should artificial shrinkage be performed prior to blastocyst vitrification? A systematic review of the literature and meta-analysis.

Boyard J1,2,3, Reignier A2,3,4, Chtourou S2,5, Lefebvre T2,4, Barrière P2,3,4, Fréour T2,3,4.

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Abstract

Embryo vitrification is increasingly used in IVF. Artificial shrinkage (collapse) before vitrification has been proposed to maximise blastocyst survival after warming. However, its effectiveness on blastocyst survival rate and vitrified-warmed blastocyst transfer cycle outcome remains to be confirmed. Therefore, we performed a systematic MEDLINE search according to PRISMA guidelines on all articles published up to April 2018 and related to human blastocyst collapse before vitrification using the following keywords: (i) blastocyst; (ii) collapse; (iii) artificial shrinkage; and (iv) vitrification. The following outcomes were analysed and included in the meta-analysis: (i) blastocyst survival rate after warming; (ii) implantation rate; (iii) clinical pregnancy rate; and (iv) live birth rate after vitrified-warmed blastocyst transfer (commonly named frozen-thawed blastocyst transfer). Eight articles were included. Briefly, blastocyst survival (OR 5.04, 95% CI 2.43-10.46) and clinical pregnancy rate (OR 1.87, 95% CI 1.26-2.77) were significantly higher in collapse than in control group. However, implantation rate (OR 2.50, 95% CI 0.67-9.28) and live birth rate (OR 1.35, 95% CI 0.88-2.09) were comparable in both groups. In conclusion, this systematic review and meta-analysis suggests that artificial shrinkage before blastocyst vitrification improves survival and clinical pregnancy rate, but not implantation or live birth rate. Further randomised studies are warranted to improve the level of evidence and confirm these findings.

精蟲玻璃話冷凍前平衡時間equilibration time 最佳時間為8分鐘

Syst Biol Reprod Med. 2020 Mar 24:1-6. doi: 10.1080/19396368.2020.1737271. [Epub ahead of print]

Optimizing the protocol for vitrification of individual spermatozoa by adjusting equilibration time.

Belenky M1, Itzhakov D1, Freger V1, Roseman O1, Abehsera S1, Miller N2,3, Berkovitz A2,3,4.

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Abstract

Efficient cryopreservation of small numbers of human spermatozoa is essential in cases of severe male infertility, especially those requiring surgical sperm retrieval. Although vitrifying individual spermatozoa on sperm vitrification devices (SpermVD®) provided optimal cell retrieval upon warming, motility rates tended to be lower than with bulk-freezing. Post-warming motility is directly affected by cryoprotectant exposure; however, optimal cryoprotectant equilibration time is unknown. We evaluated several timeframes exposing individual spermatozoa to cryoprotectant before freezing and different cryoprotectants. A total of 2,925 spermatozoa from 20 patients ranging from normozoospermic to moderate oligoteratoasthenozoospermic were vitrified in small groups, on 60 SpermVD®, in 1 µl droplets of 1:1 v/v cryoprotectant/washing medium mixture. Each group was vitrified after 2-60 minutes equilibration time. Motility of each group was evaluated after warming. Leftover pellets were frozen in cryotubes in a mixture of 1:1 v/v cryoprotectant/washing medium after 10 minutes equilibration at room temperature and 10 minutes on liquid nitrogen vapors. Post-thaw motility correlated negatively with cryoprotectant exposure time. The highest post-warming motility rate (32.1%) was observed with 8-minutes equilibration. After 10 minutes, motility rate of vitrified sperm was lower than that of bulk-freezing (31.7% vs. 37.0%, p < 0.0001). Different cryoprotectants did not affect the results. Therefore, for vitrifying small numbers of spermatozoa, we suggest maximum equilibration time of 8-minutes to achieve maximum motility after warming.

卵巢體積大小以10ml為標準
低於10ml  可發生卵巢功能下降, AMH下降 , FSH 上升

Fertil Steril. 2020 Feb;113(2):453-459. doi: 10.1016/j.fertnstert.2019.09.029.

The precise ovarian volume is significantly associated with serum concentrations of antimüllerian hormone, the luteinizing hormone/follicle-stimulating hormone ratio, and total testosterone.

Wakimoto Y1, Pors SE2, Cadenas J2, Colmorn L3, Ernst E4, Dueholm M5, Fedder J6, Mamsen LS2, Kristensen SG2, Andersen CY7.

Author information

Abstract

OBJECTIVE:

To evaluate potential associations between concentrations of antimüllerian hormone (AMH) and T as well as the LH/FSH ratio and the unbiased precise ovarian volume obtained after unilateral ovariectomy.

DESIGN:

Cohort study.

SETTING:

University hospital.

PATIENT(S):

A total of 765 patients having one ovary surgically removed for fertility preservation. Inclusion criteria were age >15 years and ovarian volume <25 mL; 386 women had one or more hormone parameter (AMH, LH, FSH, or total T) determined before oophorectomy.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

A precise weight of the ovary was equated with ovarian volume. Associations between ovarian volume and AMH, the LH/FSH ratio, T concentrations, and body mass index (BMI) were evaluated. Patient characteristics in relation to ovarian volume cutoff values between 8 and 12 mL were also examined.

RESULT(S):

Ovarian volume was significantly positively associated with concentrations of AMH, the LH/FSH ratio, and T. Ovarian volume, concentrations of AMH and LH, and the LH/FSH ratio were significantly augmented in women having ovarian volumes above a threshold of 8, 9, and 10 mL compared with those below. Average age, FSH, and T concentrations did not differ between below and above the 10 mL threshold. There was a significant association between BMI and ovarian volume and BMI and T, while other hormone parameters were nonsignificant.

CONCLUSION(S):

The precise ovarian volume reflected ovarian activity measured as circulating concentrations of AMH and T as well as the LH/FSH ratio. These significant associations showed continuous progression, and a 10 mL threshold offered no clear difference compared with other volume threshold values.

ET胚胎植入管合併細菌感染機率約22%
一旦植入管合併細菌感染，懷孕率為%

J Gynecol Obstet Hum Reprod. 2020 Mar 12:101727. doi: 10.1016/j.jogoh.2020.101727. [Epub ahead of print]

Does bacterial colonization during embryo transfer have an impact on pregnancy rate in ICSI? : Tunisian preliminary results.

Hamdoun M1, Braham M2, Kacem K3, Hannachi H4, Zhioua F5, Chakroun N6, Bahri O7.

Author information

Abstract

INTRODUCTION:

Embryos' transfer into the uterine cavity remains a limiting factor in the success of intracytoplasmic sperm injection (ICSI). This study aimed to evaluate the impact of cervico-vaginal colonization on ICSI outcomes.

MATERIEL AND METHODS:

Longitudinal, prospective and analytical study, conducted from February 1 st to October 31 st, 2017. On the day of embryos' transfer, patients with the following criteria were included: Age ≤ 40, normal uterine ultrasound and hysteroscopy, first or second attempt of ICSI, use of fresh semen and transfer of at least one good quality embryo. Three samples were done for microbiological analysis: vaginal secretions, cervical mucus and the tip of the transfer catheter.

RESULTS:

The study included 40 patients. Pregnancy rate was 52.5%. Catheter contamination occurred in nine cases (22.5%). The most frequently isolated bacteria were Streptococcus anginosus (37% of cases), Gardnerella vaginalis (27% of cases) and Streptococcus agalactiae (18% of cases). In all cases of contamination, the same bacteria were found also in the vagina and cervical mucus. In cases of contamination with Gardnerella vaginalis, the study of vaginal flora showed bacterial vaginosis. No pregnancy was obtained when contamination of the transfer catheter occurred. In the absence of contamination, pregnancy rate was 61.2% (ρ = 0.003). Both populations (patients with catheter contamination and patients without catheter contamination) were comparable regarding epidemiological characteristics and ICSI attempt data.

CONCLUSION:

Contamination of the transfer catheter by cervical-vaginal bacteria appears to affect IVF results. Systematic antibiotic prophylaxis could be proposed to reduce this negative impact.

PGS囊胚切片TE代表ICM染色體之準確率約98%
PGS檢測結果為aneuploidy and euploidy 準確率> 95%
PGS檢測結果為 準確率只有35.2%

J Assist Reprod Genet. 2020 Feb 28. doi: 10.1007/s10815-020-01720-x. [Epub ahead of print]

The reproducibility of trophectoderm biopsies in euploid, aneuploid, and mosaic embryos using independently verified next-generation sequencing (NGS): a pilot study.

Sachdev NM1,2, McCulloh DH3, Kramer Y3, Keefe D3, Grifo JA3.

Author information

Abstract

PURPOSE:

To assess the accuracy and reliability of comprehensive chromosome screening by next-generation sequencing (NGS) of human trophectoderm (TE) biopsy specimens.

METHODS:

The reliability and accuracy of diagnoses made by preimplantation genetic testing for aneuploidy (PGT-A) from TE biopsy were tested. Repeat biopsies of TE and inner cell mass (ICM) samples were obtained from thawed blastocysts previously tested by NGS. To test for the reliability of the NGS assay, biopsy samples were compared with the original PGT-A results. Prior NGS testing classified the TE samples as euploid, aneuploid, or aneuploid-mosaic. The resulting re-biopsied samples underwent SurePlex whole genome amplification followed by NGS via the MiSeq platform, with copy number value (CNV) determined using BlueFuse Multi Software. The primary outcome measure was reliability, defined as concordance between initial TE result and the repeat biopsies. Accuracy was determined by concordance between the TE and ICM samples, and compared between three chromosome types (disomic, aneuploid, and mosaic).

RESULTS:

Re-biopsies were performed on 32 embryos with prior PGT-A showing euploidy (10 embryos), aneuploidy of one or two chromosomes (4 embryos), or aneuploid-mosaic with one aneuploid chromosome and one mosaic chromosome (18 embryos). One hundred twenty-nine biopsy samples completed NGS (90 TE and 39 ICM biopsies) and 105 biopsy results were included in the analysis. TE biopsies provide a highly accurate test of the future fetus, with the ICM disomic concordance rate of 97.6%. Clinical concordance rates indicate that TE biopsies provide a reliable test when the result is euploid (99.5%) or aneuploid (97.3%), but less reliable when the result is mosaic (35.2%).

CONCLUSION:

TE biopsies predict euploidy or aneuploidy in the ICM with a high degree of accuracy. PGT-A with NGS of TE biopsies is shown to be highly reliable, with clinically relevant concordance rates for aneuploidy and euploidy over 95%. TE biopsies indicating mosaicism were less reliable (35.2%), presumably because mitotic non-disjunction events are not uniformly distributed throughout the blastocyst. However, classification of TE biopsy of PGT-A with NGS results as either aneuploid or euploid provides a highly reliable test.

胚胎內部PH調控機轉包括
Na+/H+ and HCO3-/Cl- exchangers
外在影響因素包括
temperature, medium composition, duration of culture, or implication of CO2

J Assist Reprod Genet. 2020 Mar 2. doi: 10.1007/s10815-020-01726-5. [Epub ahead of print]

Need for choosing the ideal pH value for IVF culture media.

Gatimel N1,2, Moreau J3,4, Parinaud J3,4, Léandri RD3,4.

Author information

Abstract

PURPOSE:

Monitoring the pH of IVF culture media is a good practice, but the required pH levels have been "arbitrarily" set. Assisted reproductive technology centers around the world are spending time and money on pH monitoring without any consensus to date. The objective of this narrative review was to evaluate the importance of pH monitoring during IVF, discover how the oocyte and embryo regulate their intracellular pH and try to determine the optimal pH to be applied.

METHODS:

A narrative literature review was performed on publications in the PubMed database reporting on the impact of pH on cellular function, oocyte and embryo development, IVF outcomes and pathophysiology, or on physiological pH in the female reproductive tract.

RESULTS:

Intracellular pH regulates many cellular processes such as meiotic spindle stability of the oocyte, cell division and differentiation, embryo enzymatic activities, and blastocoel formation. The internal pH of the human embryo is maintained by regulatory mechanisms (mainly Na+/H+ and HCO3-/Cl- exchangers) that can be exceeded, particularly in the oocyte and early-stage embryos. The opinion that the optimal pH for embryo culture is physiological pH is not correct since several physicochemical parameters specific to IVF culture conditions (temperature, medium composition, duration of culture, or implication of CO2) can modify the intracellular pH of the embryo and change its needs and adaptability.

CONCLUSIONS:

Because correct and stable extracellular pH is essential to embryo health and development, monitoring pH is imperative. However, there is a lack of clinical data on choosing the ideal pH for human IVF culture media.

白種人黃種人之囊胚形成率無統計差異

體重過重vs體重正常之囊胚形成率無統計差異

J Assist Reprod Genet. 2020 Mar 4. doi: 10.1007/s10815-020-01706-9. [Epub ahead of print]

Blastocyst formation rate for Asians versus Caucasians and within body mass index categories.

Khunte R1, Li M2, Behr B3, Zhao Q3, Baker VL4.

Author information

Abstract

PURPOSE:

There are well-documented racial and ethnic disparities for in vitro fertilization (IVF) outcomes, including disparities in clinical pregnancy and live birth rate. Obesity has also been associated with an increase in the risk of infertility and reduction in the efficacy of fertility treatment. However, there are limited data regarding the potential effect of race and obesity on in vitro embryo development. The purpose of this study was to determine whether blastocyst formation rates vary with race and body mass index (BMI).

METHODS:

This retrospective analysis included 1134 fresh autologous cycles (N = 8266 embryos), which took place from January 2013 to December 2016. Women were categorized as Caucasian, Asian (not Indian), and Indian (South Asian) and by BMI categories (normal, overweight, and obese). Regression analyses were performed using race and BMI as the primary predictor variables and blastocyst formation as the outcome.

RESULTS:

Compared to Caucasian, the adjusted OR for blastocyst development was 0.85 (95% CI 0.72-1.00) for Asian women and 1.15 (95% CI 0.95-1.38) for Indian women. Women who were overweight (aOR 0.93; 95% CI 0.77-1.12) or obese (aOR 0.92; 95% CI 0.74-1.12) had similar odds of blastocyst formation comparing to women with normal BMI. Furthermore, analyses examining combined effects of race and BMI revealed no differences in blastocyst formation among Asian or Indian women with varied BMI categories compared to Caucasian women with normal BMI.

CONCLUSION:

Blastocyst formation did not differ based on race or BMI.

縱使染色體正常  高齡染色體正常胚胎植入 ET  仍比年青染色體正常 正常胚胎植入活產率低
顯示高齡對於懷孕率之影響層面不僅僅只是染色體正常與否

J Assist Reprod Genet. 2020 Mar 16. doi: 10.1007/s10815-020-01739-0. [Epub ahead of print]

The impact of age beyond ploidy: outcome data from 8175 euploid single embryo transfers.

Reig A1, Franasiak J2,3, Scott RT Jr2,3, Seli E4,5.

Author information

Abstract

PURPOSE:

The rate of embryonic aneuploidy increases with increasing female age and is the primary cause of lower pregnancy and live birth rates (LBR) in older reproductive age women. This retrospective cohort study evaluates single euploid embryo transfers to determine whether an age-related decline in reproductive efficiency persists.

METHODS:

A total of 8175 non-donor single embryo transfers (SET) after pre-implantation testing for aneuploidy (PGT-A) and cryopreservation were included. These were divided into five groups by patient age: < 35 years old (n = 3789 embryos transferred), 35-37 (n = 2200), 38-40 (n = 1624), 41-42 (n = 319), and > 42 (n = 243). Implantation rate (IR), clinical pregnancy rate (CPR), and LBR were calculated for each group as a percentage of embryos transferred and compared. CPR was also analyzed as a percentage of implanted pregnancies, and LBR as a percentage of clinical pregnancies, to determine when age has the greatest impact. These results were then adjusted for confounding variables via a multivariate logistic regression model.

RESULTS:

Implantation rates negatively correlated with age. After adjusting for confounders, women 38 years or older had a significantly lower IR than those under 35 (OR 0.85, 95%CI 0.73-0.99 for 38-40 years old; 0.69, 0.53-0.91 for 41-42, and 0.69, 0.51-0.94 for > 42). These differences are also apparent in CPR and LBR. The rates of progression to clinical pregnancy and live birth did not differ significantly by age group. Other factors observed to affect IR independently were anti-Müllerian hormone (AMH), day of embryo transfer, and embryo morphology.

CONCLUSION:

While selection of euploid embryos may be effective in overcoming a significant proportion of the age-related decline in reproductive efficiency, a decrease in IR, CPR, and LBR persists even when analyzing only euploid embryo transfers. The observed impact of aging is, therefore, independent of ploidy, as well as of other variables that affect reproductive efficiency. These results indicate that factors other than aneuploidy contribute to reproductive senescence.

超長療程GnRHa無法明顯提高IVF-ET懷孕率

Fertil Steril. 2020 Mar 5. pii: S0015-0282(19)32620-2. doi: 10.1016/j.fertnstert.2019.12.018. [Epub ahead of print]

Ultralong administration of gonadotropin-releasing hormone agonists before in vitro fertilization improves fertilization rate but not clinical pregnancy rate in women with mild endometriosis: a prospective, randomized, controlled trial.

OBJECTIVE:

To evaluate the effects of gonadotropin-releasing hormone agonists (GnRH-a) on fertility in women with mild endometriosis who are undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures.

DESIGN:

Prospective, randomized, controlled trial.

SETTING:

Three tertiary university hospitals.

PATIENT(S):

Four hundred infertile women with mild endometriosis, documented with laparoscopy, undergoing IVF and 200 women with tubal factor infertility.

INTERVENTION(S):

Administration of GnRH-a for 3 months before an IVF attempt (group A, n = 200) or IVF without GnRH-a (group B, n = 200).

MAIN OUTCOME MEASURE(S):

Follicular fluid (FF) levels of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8, and IL-1 receptor antagonist; fertilization rate (FR), implantation rate (IR), quality of embryos, and clinical pregnancy rate (PR).

RESULT(S):

Women who received GnRH-a had a statistically significantly reduced concentration of FF cytokines compared with women who did not receive this regimen. Women in group B had a reduced FR (61.7; 95% CI, 59.20-64.20) compared with the women in group A (72.7; 95% CI, 70.50-74.90) and compared with the women with tubal factor infertility (74.7; 95% CI, 72.00-77.24). The embryo quality, IR, and clinical PR showed no statistically significant improvement in the women of group A compared with group B.

CONCLUSION(S):

Women who received GnRH-a for 3 months had a lower concentration of FF cytokines. These women had also a higher FR than the women who did not receive GnRH-a. However, the IR, embryo quality, and clinical PR showed no statistically significant difference when comparing the two groups. CLINICALTRIALS.

子宮內膜異位IVF前施打3月GnRHa (vs 無施打GnRHa) 無明顯提高懷孕率PR, IR, 胚胎品質

Fertil Steril. 2020 Mar 5. pii: S0015-0282(19)32620-2. doi: 10.1016/j.fertnstert.2019.12.018. [Epub ahead of print]

Ultralong administration of gonadotropin-releasing hormone agonists before in vitro fertilization improves fertilization rate but not clinical pregnancy rate in women with mild endometriosis: a prospective, randomized, controlled trial.

Kaponis A1, Chatzopoulos G2, Paschopoulos M2, Georgiou I2, Paraskevaidis V2, Zikopoulos K2, Tsiveriotis K3, Taniguchi F4, Adonakis G3, Harada T4.

Author information

Abstract

OBJECTIVE:

To evaluate the effects of gonadotropin-releasing hormone agonists (GnRH-a) on fertility in women with mild endometriosis who are undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures.

DESIGN:

Prospective, randomized, controlled trial.

SETTING:

Three tertiary university hospitals.

PATIENT(S):

Four hundred infertile women with mild endometriosis, documented with laparoscopy, undergoing IVF and 200 women with tubal factor infertility.

INTERVENTION(S):

Administration of GnRH-a for 3 months before an IVF attempt (group A, n = 200) or IVF without GnRH-a (group B, n = 200).

MAIN OUTCOME MEASURE(S):

Follicular fluid (FF) levels of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8, and IL-1 receptor antagonist; fertilization rate (FR), implantation rate (IR), quality of embryos, and clinical pregnancy rate (PR).

RESULT(S):

Women who received GnRH-a had a statistically significantly reduced concentration of FF cytokines compared with women who did not receive this regimen. Women in group B had a reduced FR (61.7; 95% CI, 59.20-64.20) compared with the women in group A (72.7; 95% CI, 70.50-74.90) and compared with the women with tubal factor infertility (74.7; 95% CI, 72.00-77.24). The embryo quality, IR, and clinical PR showed no statistically significant improvement in the women of group A compared with group B.

CONCLUSION(S):

Women who received GnRH-a for 3 months had a lower concentration of FF cytokines. These women had also a higher FR than the women who did not receive GnRH-a. However, the IR, embryo quality, and clinical PR showed no statistically significant difference when comparing the two groups. CLINICALTRIALS.

Day5達到囊胚  染色體正常率為68%
Day6達到囊胚  染色體正常率為52%
Day7達到囊胚  染色體正常率為43%
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染色體正常Day5囊胚, 著床率約69%
染色體正常Day6囊胚, 著床率約67%
染色體正常Day7囊胚, 著床率約53%

Hum Reprod. 2019 Sep 29;34(9):1632-1639. doi: 10.1093/humrep/dez138.

Worth the wait? Day 7 blastocysts have lower euploidy rates but similar sustained implantation rates as Day 5 and Day 6 blastocysts.

Tiegs AW1,2, Sun L3, Patounakis G4, Scott RT1,2.

Author information

Abstract

STUDY QUESTION:

Does the reproductive potential of embryos change when blastocyst development takes longer than the traditionally accepted 5 days when accounting for aneuploidy and endometrial-embryo asynchrony?

SUMMARY ANSWER:

Aneuploidy increases with increasing duration of blastulation, but if blastocyst morphologic quality and endometrial-embryo asynchrony are controlled for, euploid Day 7 embryos have similar sustained implantation as compared to Days 5 and 6 euploid blastocysts.

WHAT IS KNOWN ALREADY:

The relative contributions of diminished embryo quality versus endometrial and embryo asynchrony to poor outcomes associated with embryos cultured past Day 6 are not clear. Asynchrony can be eliminated by embryo vitrification with transfer in a subsequent month after retrieval.

STUDY DESIGN, SIZE, DURATION:

Retrospective cohort study of patients from a single center attempting conception through ICSI and utilizing preimplantation genetic testing for aneuploidy screening (PGT-A) from January 2017 to September 2018. Cycles were excluded if they utilized surgical sperm or preimplantation genetic testing for monogenetic/single gene defects. ICSI cycle outcomes from 2586 patients were evaluated for ploidy status of embryos.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Only patients undergoing single, euploid frozen embryo transfer were included when analyzing cycle outcomes by day of blastocyst expansion of the transferred embryo (n = 2130). Ploidy rates by the day upon which an embryo was considered to be usable (denoted, 'usable blastulation day') were determined so as to assess the contribution of aneuploidy to slow embryo development. Outcomes of euploid frozen single embryo transfers (SET) of Day 7 embryos were evaluated to assess the reproductive potential associated with embryos that were slowly developing for reasons other than aneuploidy. Analyses were adjusted by maternal age and blastocyst morphology.

MAIN RESULTS AND THE ROLE OF CHANCE:

Overall, 67.7% (n = 3508) of usable Day 5 blastocysts were euploid, 52.1% (n = 5560) of usable Day 6 blastocysts were euploid and 43.1% (n = 229) of usable Day 7 embryos were euploid (Day 5 versus Day 6: odds ratio (OR) 0.7 (95% CI, 0.64-0.76), P < 0.001; Day 5 versus Day 7: OR 0.56 (95% CI, 0.46-0.69), P < 0.001; Day 6 versus Day 7: OR 0.81 (95% CI, 0.67-0.99), P = 0.036). Stratified by Society for Assisted Reproductive Technology maternal age groups, a reduction in the prevalence of euploidy by increasing time to embryo blastulation was still seen. The sustained implantation rate (SIR) was similar after euploid SET of Days 5 and 6 embryos (overall, 68.9% (95% CI, 66.0-71.6) and 66.8% (95% CI, 63.8-69.7), respectively; P = 0.81). SIR after euploid Day 7 SET appeared slightly lower than that of Days 5 and 6 embryos (52.6% (95% CI, 35.8-69.0); (Day 5 versus Day 7: OR, 0.67 (95% CI, 0.32-1.41), P = 0.29; Day 6 versus Day 7: OR 0.58 (95% CI, 0.28-1.2), P = 0.14)) but did not achieve statistical significance.

高齡不孕病患(非男姓不孕)施行ICSI vs IVF 卵子受孕率無明顯差異

Fertil Steril. 2020 Feb;113(2):354-363.e1. doi: 10.1016/j.fertnstert.2019.09.035.

Comparing fertilization rates from intracytoplasmic sperm injection to conventional in vitro fertilization among women of advanced age with non-male factor infertility: a meta-analysis.

Sunderam S1, Boulet SL2, Kawwass JF3, Kissin DM4.

Author information

Abstract

OBJECTIVE:

To evaluate the effectiveness of intracytoplasmic sperm injection (ICSI) in improving fertilization rates compared to conventional in vitro fertilization rates (IVF) among women aged ≥38 years with a non-male factor diagnosis.

DESIGN:

Systematic review and meta-analysis.

SETTING:

Not applicable.

PATIENT(S):

Women aged ≥38 years with a non-male factor diagnosis receiving IVF or ICSI.

INTERVENTION(S):

A systematic review of databases including PubMed and Embase was performed. Study protocol was registered at the International Prospective Register of Systematic Reviews. Studies were selected if they compared fertilization rates from ICSI with those from conventional IVF among women aged ≥38 years with a non-male factor infertility diagnosis. A random effects model was used. Meta-analysis of Observational Studies in Epidemiology guidelines were applied.

MAIN OUTCOME MEASURE(S):

Fertilization rate.

RESULTS:

Seven studies including 8796 retrieved oocytes (ICSI: 4,369; IVF: 4,427) with mean female age ≥38 years met the inclusion criteria. There was no significant difference in fertilization rates between ICSI and conventional IVF (relative risk [RR] 0.99, 95% confidence interval [CI] 0.93-1.06; P = .8). Heterogeneity was observed between studies (I2 = 58.2; P < .05). Heterogeneity was significant (I2 = 57.1; P < .05) when cycles with prior fertilization failure were excluded; however, when analysis was restricted to poor responders (RR 1.01, 95% CI 0.97-1.05; P = .6), heterogeneity was no longer significant (I2 = 0.0; P = .5).

CONCLUSIONS:

No difference was found in fertilization rates between conventional IVF and ICSI. Further studies are needed to assess the impact of ICSI in this population, controlling for other indications such as preimplantation genetic testing.

Published by Elsevier Inc.