AUTHOR=Huang Jun-Xia , Gao Yu-Qi , Chen Xiao-Tong , Han Ying-Qi , Song Jing-Yan , Sun Zhen-Gao 

TITLE=Impact of intracytoplasmic sperm injection in women with non-male factor infertility: A systematic review and meta-analysis

JOURNAL=Frontiers in Reproductive Health

VOLUME=Volume 4 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2022.1029381

DOI=10.3389/frph.2022.1029381

ISSN=2673-3153

ABSTRACT=Objective The purpose of this study is to determine whether intracytoplasmic sperm injection (ICSI) is beneficial in patients with non-male factor infertility.
Methods This systematic review and meta-analysis included articles from inception to May, 2022. Published studies of non-male factor infertile women undergoing ICSI or in vitro fertilization (IVF) included in PubMed, Embase, web of science, Wanfang Database, and CNKI were searched by computer, without language restrictions. Random-effect model was applied to calculate the risk ratios (RRs) and their 95% confidence intervals (95% CIs). Letters, case reports, review articles including meta-analyses and expert opinions were excluded. The pri-mary endpoints were laboratory outcomes including fertilization rate and total fertilization failure rate. Secondary endpoints were maternal and neonatal outcomes.
Results Six randomized controlled studies and 20 retrospective cohort studies met the inclu-sion criteria. In meta-analytic forest plots, compared with IVF, those who received ICSI treatment were not different in fertilization rate (RR=0.90,95% CI [0.90-1.09],P=0.88), total fertilization failure rate (RR=1.11,95% CI [0.83-1.48], P=0.48), and good-quality embryos rate (RR=0.94,95% CI [ 0.86-1.02], P=0.15), clinical pregnancy rate (RR=0.84, 95% CI [0.70-1.01], P=0.06), live birth rate (RR=0.89, 95% CI [0.77-1.03], P=0.13), miscarriage rate (RR=1.06, 95% CI [0.78-1.43], P=0.71), preterm neonatal delivery rate (RR=0.92, 95% CI [0.67-1.26], P=0.61), and low neonatal weight rate (RR=1.13, 95% CI [0.80-1.61], P=0.48). However, the implanta-tion rate of IVF was better than ICSI (RR=0.77, 95% CI [0.64-0.93], P=0.005). In the subgroup analysis of live birth rate of fresh embryo transfer, IVF performed in those ≥ 35 years had a higher live birth rate (RR=0.82, 95% CI [0.78-0.83], P<0.001). 
Conclusion The findings of this study indicate that ICSI is not superior to IVF in the treat-ment of infertility related to non-male factors. In order to confirm this result, more high-quality clinical studies are needed.