Regular (ICSI) versus ultra‐high magnification (IMSI) sperm selection for assisted reproduction

摘要: BACKGROUND Subfertility is a condition found in up to 15% of couples reproductive age. Gamete micromanipulation, such as intracytoplasmic sperm injection (ICSI), very useful for treating with compromised parameters. An alternative method selection has been described; the spermatozoa are selected under high magnification (over 6000x) and used ICSI. This technique, named morphologically (IMSI), theoretical potential improve outcomes among undergoing assisted reproduction techniques (ART). However, our previous version this Cochrane Review was unable find evidence that supported possible beneficial effect. an update Teixeira 2013. OBJECTIVES To identify, appraise, summarise available regarding efficacy safety IMSI compared ICSI ART. SEARCH METHODS We searched randomised controlled trials (RCTs) these electronic databases: Gynaecology Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, trial registers: ClinicalTrials.gov World Health Organization International Clinical Trials Registry Platform. also handsearched reference lists included studies similar reviews. performed last search on 18 November 2019. SELECTION CRITERIA only considered RCTs IMSI; we did not include quasi-randomised trials. permitted inclusion same participant more than once (cross-over or per cycle trials) if data first treatment each were available. DATA COLLECTION AND ANALYSIS Two review authors independently study selection, extraction, assessment risk bias quality evidence; solved disagreements by consulting third author. corresponded investigators resolve any queries, required. MAIN RESULTS The updated retrieved 535 records; 13 parallel-designed comparing (four added since version), comprising 2775 (IMSI = 1256; 1519). uncertain improves live birth rates (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.89 1.39; 5 studies, 929 couples; I² 1%), miscarriage couple (RR 1.07, CI 0.78 1.48; 10 2297 0%, very-low evidence), rate pregnancy 0.90, 0.68 1.20; 783 evidence). clinical 1.23, 1.11 1.37; 47%, None reported congenital abnormalities. judged all be low-quality. downgraded due limitations bias), inconsistency results, strong indication publication bias. AUTHORS' CONCLUSIONS current from does support refute use (intracytoplasmic (IMSI). chances having miscarriage. low-quality may increase pregnancy, which means still about real difference. reporting Well-designed sufficiently powered