Trends in the use of intracytoplasmic sperm injection in the United States
Trends in the use of intracytoplasmic sperm injection in the United States
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DOI：
10.1056/nejmsa070707
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发表时间：
2007-07-19
影响因子：
158.5
通讯作者：
Gupta, Ruchi S.
中科院分区：
文献类型：
--
作者：
Jain, Tarun;Gupta, Ruchi S.
背景：卵胞浆内单精子注射（ICSI）最初是作为体外受精（IVF）治疗男性因素不育的一部分而发展起来的。然而，尽管ICSI增加了成本、不确定的疗效和潜在的风险，它的使用已经扩展到一些没有男性因素不育的患者。方法：我们分析了向疾病控制和预防中心报告的有关辅助生殖技术的国家数据，以确定美国ICSI和IVF使用的时间趋势，并检查了有和没有强制保险覆盖的州之间ICSI使用的差异。结果：1995 - 2004年，生育诊所数量、新鲜胚胎周期、ivf相关妊娠率和活产率均有所增加。使用ICSI的试管婴儿周期的百分比也急剧增加（从11.0%增加到57.5%），而男性因素导致的不孕症诊断的百分比保持稳定。男性因素不育的ICSI诊断比例逐年稳步上升，表明除男性因素不育外，ICSI的使用也在增加。从1999年到2004年，在有和没有强制保险覆盖的州，相对于男性因素不育患者的百分比，ICSI的使用有所增加。然而，对于任何给定的年份，有保险覆盖的州使用ICSI诊断男性因素不育的比例高于没有保险覆盖的州(P
Background: Intracytoplasmic sperm injection (ICSI) was initially developed as part of in vitro fertilization (IVF) to treat male-factor infertility. However, despite the added cost, uncertain efficacy, and potential risks of ICSI, its use has been extended to include some patients without documented male-factor infertility.Methods: We analyzed national data on assisted reproductive technology reported to the Centers for Disease Control and Prevention, to determine temporal trends in the use of ICSI and IVF in the United States, and we examined differences in the use of ICSI between states with and those without mandated insurance coverage.Results: From 1995 to 2004, the number of fertility clinics and fresh-embryo cycles and the rates of IVF-related pregnancies and live births increased. The percentage of IVF cycles with the use of ICSI also increased dramatically (from 11.0% to 57.5%), while the percentage of diagnoses of infertility attributed to male-factor conditions remained stable. The ratio of ICSI procedures to diagnoses of male-factor infertility steadily increased each year, suggesting an increasing use of ICSI for conditions other than male-factor infertility. From 1999 to 2004, there was an increasing use of ICSI relative to the percentage of patients with male-factor infertility in states with and those without mandated insurance coverage. For any given year, however, states with insurance coverage had a higher ratio of ICSI use to diagnoses of male-factor infertility than did states without insurance coverage (P