Higher clinical pregnancy rate with In-vitro Fertilization versus Intracytoplasmic Sperm Injection in treatment of non-male factor infertility: systematic review and meta-analysis

Objective: To evaluate the evidence about in-vitro fertilization (IVF) versus intracytoplasmic sperm injection (ICSI) for the treatment of non-male factor infertility. Data sources: Electronic databases searched using the following MeSH terms (Sperm Injection, Intracytoplasmic) AND (in Vitro Fertilisation) AND (Infertility). Methods of study selection: All RCTs included infertile patients due to non-male factors underwent IVF or ICSI were considered for this meta-analysis. One-thousand twenty-two studies were identified of which 20 studies deemed eligible for this review. Data extraction: Three independent authors extracted the relevant data from included studies. The study outcomes were pooled in the form of relative risk (RR) and 95 % confidence interval (CI) using Mantel-Hansel method. The main outcome measures are the fertilization rate, the implantation rate, the clinical pregnancy rate (CPR), the total fertilization failure and the live birth rate. Results: Regarding the fertilization rate, the pooled estimate did not favour either IVF or ICSI group (RR = 0.94; 95 %CI [0.82,1.07]; p = 0.34). However, IVF significantly increased the CPR than ICSI (RR = 1.28, 95 %CI [1.11, 1.49]; p = 0.001). The overall effect estimate did not favor either of two groups regarding the implantation rate (RR = 1.25, 95 % CI [0.92, 1.68], p = 0.15). Similarly, no difference between both groups regarding the live birth rate (RR = 1.08, 95 % CI [0.79, 1.49]; p = 0.62). Conclusions: No difference between ICSI and IVF regarding fertilization rate per oocytes, implantation rate and live birth rate in the treatment of non-male factor infertility, while IVF has significantly higher clinical pregnancy rate and higher risk of total fertilization failure. (C) 2020 Elsevier Masson SAS. All rights reserved.