Does intracytoplasmic sperm injection improve the fertilization rate and decrease the total fertilization failure rate in couples with well defined unexplained infertility A systematic review and meta analysis

Capsule:
This meta-analysis of couples with well defined unexplained infertility undergoing IVF favors the use of intracytoplasmic sperm injection to increase fertilization rates and decrease the risk of total fertilization failure.

Authors:
Lauren N. C. Johnson, M.D., Isaac E. Sasson, M.D., Ph.D., Mary D. Sammel, Sc.D., Anuja Dokras, M.D., Ph.D.

Volume 100, Issue 3, Pages 704-711, September 2013

Abstract:

Objective:
To determine if intracytoplasmic sperm injection (ICSI), compared with conventional insemination, improves fertilization rates and prevents total failed fertilization (TFF) in couples with unexplained infertility.

Design:
Systematic review and meta-analysis.

Setting:
IVF centers.

Patient(s):
Couples with well-defined unexplained infertility undergoing IVF.

Intervention(s):
A systematic review was performed by searching Medline and Embase for 1992–2012. Studies in which sibling oocytes were randomly split between conventional insemination and ICSI were included. A random effects model was utilized for the meta-analysis. Meta-analysis of Observational Studies in Epidemiology guidelines were applied.

Main Outcome Measure(s):
Fertilization rate and TFF rate by insemination method.

Result(s):
Eleven studies with a total of 901 couples (female age range 30–35 years) with 11,767 sibling oocytes were included in the meta-analysis. The pooled relative risk (RR) of a mature oocyte fertilizing was higher with ICSI than with conventional insemination (RR 1.49, 95% confidence interval [CI] 1.35–1.65.) The pooled RR of fertilization per allocated oocyte (before randomization) was higher with ICSI than with conventional insemination (RR 1.27, 95% CI 1.02–1.58; n = 5 studies.) The pooled RR of TFF was significantly higher with conventional insemination than with ICSI (RR 8.22, 95% CI 4.44–15.23). The number of subjects needed to treat with ICSI to prevent one case of TFF was five.

Conclusion(s):
This meta-analysis favors the use of ICSI to increase fertilization rates and decrease the risk of TFF in couples with well-defined unexplained infertility. Further studies are needed to determine the impact on clinical pregnancy and live birth rate.

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