{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T21:56:54Z","timestamp":1780351014788,"version":"3.54.1"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004775","name":"Natural Science Foundation of Gansu Province","doi-asserted-by":"publisher","award":["21JR1RA102"],"award-info":[{"award-number":["21JR1RA102"]}],"id":[{"id":"10.13039\/501100004775","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The use of intracytoplasmic sperm injection (ICSI) has dramatically increased in patients with non\u2010male factor infertility during the last decades. However, whether ICSI provides a significant benefit over in\u00a0vitro fertilization (IVF) in these patients is still controversial. In this study, we aimed to investigate the efficacy of ICSI on reproductive outcomes with non\u2010male factor infertility and to provide updated evidence for clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2023. Randomized controlled trials (RCTs) comparing the efficacy between ICSI and IVF in patients with non\u2010male factor infertility were included. The main outcomes were the live birth rate (LBR), fertilization rate (FR), and total fertilization failure (TFF). The pooled estimates were calculated using the random\u2010effects models as relative risk (RR) with 95% confidence intervals (CIs). This systematic review and meta\u2010analysis was registered in PROSPERO (CRD42023427004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 18 RCTs with 3249\u2009cycles and 30\u2009994 oocytes. The results demonstrated that ICSI reduced the risk of TFF (RR\u2009=\u20090.26, 95% CI: 0.13\u20130.50, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200958%) and increased FR per oocyte inseminated\/injected (RR\u2009=\u20091.14, 95% CI: 1.08\u20131.20, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200969%), but it did not improve LBR (RR\u2009=\u20091.11, 95% CI: 0.94\u20131.30, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u20090%) or other outcomes compared with IVF. However, the difference in fertilization failure reduction between ICSI and IVF may be explained by different randomization methods (randomization based on patients vs. sibling oocytes). When considering only studies with randomization based on patients, we found no evidence of the difference between the groups (RR\u2009=\u20090.72, 95% CI: 0.48\u20131.06, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u20090%). Furthermore, no differences were observed in subgroup analyses based on other factors, including female age, study period, and controlled ovarian stimulation protocols.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest that ICSI leads to no difference in reproductive outcomes compared to IVF in patients with non\u2010male factor infertility. Considering the cost and safety of ICSI, we have no evidence to support the routine use of ICSI in these populations. High\u2010quality RCTs with large sample sizes will be needed to confirm our results and explore clinical and neonatal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14698","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T13:27:47Z","timestamp":1699277267000},"page":"30-41","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Efficacy of intracytoplasmic sperm injection in women with non\u2010male factor infertility: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"103","author":[{"given":"Liu","family":"Yang","sequence":"first","affiliation":[{"name":"The First Clinical Medical College, Lanzhou University  Lanzhou China"},{"name":"The First Hospital of Lanzhou University  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuxiang","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, the Second Affiliated Hospital School of Medicine, Zhejiang University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongyan","family":"Zhu","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College, Lanzhou University  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7216-0383","authenticated-orcid":false,"given":"Xuehong","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College, Lanzhou University  Lanzhou China"},{"name":"The First Hospital of Lanzhou University  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)92425-F"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew092"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.17985"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa090"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/hropen\/hoaa032"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2006.12.013"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8101694"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-006-9060-2"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2013.04.038"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-020-01970-9"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2022.1029381"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2019.09.035"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00535-3"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa002"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-020-01990-5"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2020.101990"},{"key":"e_1_2_9_18_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (Updated February 2021)","author":"Higgins JP","year":"2021"},{"issue":"10","key":"e_1_2_9_19_1","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"10","author":"Cumpston M","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_20_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.2.0 (Updated June 2017)","author":"Higgins JP","year":"2017"},{"key":"e_1_2_9_21_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (Updated February 2022)","author":"Sch\u00fcnemann H","year":"2022"},{"key":"e_1_2_9_22_1","volume-title":"McMaster University (developed by Evidence Prime) GRADEpro GDT","author":"GRADEpro","year":"2022"},{"key":"e_1_2_9_23_1","volume-title":"The Cochrane Collaboration Review Manager Web (RevMan Web). 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