A Danish national cohort of 730 infants born after intracytoplasmic sperm injection (ICSI) 1994–1997

Abstract

This national cohort study included all clinical pregnancies obtained after intracytoplasmic sperm injection (ICSI) registered in Denmark between January 1994 and July 1997 at five public and eight private fertility clinics. Laboratory and clinical data were obtained from the fertility clinics. The couples answered a questionnaire regarding the pregnancy and the health of the child (response rate 94%). Data validation was carried out through discharge charts. The mean age of the women was 32.1 years. In 84.2% of couples, male factor was the main reason for performing ICSI, and in 4.8% epididymal spermatozoa were used. The mean number of embryos replaced was 2.3 (range 1-3) and in 95% of cases fresh embryos were transferred. Only 183 women (28.5%) underwent prenatal diagnosis, resulting in 209 karyotypes with seven (3.3%) chromosome aberrations. Six major chromosomal abnormalities (2.9%) and one inherited structural chromosome aberration (0.5%) were found, but no sex chromosome aberrations. The frequency of multiple birth, Caesarean section rate, gestational age, preterm birth, and birth weight were comparable with previous studies. The perinatal mortality rate was 13.7 per 1000 children born with a gestational age of 24 weeks or more. In 2.2% (n = 16) of the liveborn infants, and in 2.7% (n = 20) of all infants, major birth defects were reported by the parents. Minor birth defects were found in nine liveborn infants (1.2%). In conclusion, the results of this study on outcome of ICSI pregnancies are in line with earlier reports, except that no sex chromosome abnormalities were found.

Comparison of embryo quality between intracytoplasmic sperm injection and in vitro fertilization in sibling oocytes

“…Moreover, since the ICSI procedure itself is more invasive questions regarding safety issues have been raised. Several studies have demonstrated that there is no increase in the incidence of congenital anomalies in children born after ICSI compared with standard IVF or with the general population [29][30][31][32][33][34][35][36]. However, others showed that infants born after ICSI might indeed have an excess of major birth defects [37][38][39] and an increased incidence of chromosomal abnormalities [31,35].…”

Incidência de malformações congênitas em crianças concebidas através de injeção intracitoplasmática de espermatozóides

“…Como algumas malformações manifestam-se ou são notadas pelos pais e/ou médicos mais tardiamente e a evolução do quadro pode modificar a classificação da malformação entre maior ou menor (p.ex. : necessidade de correção cirúrgica, fechamento espontâ-neo de defeito de septo cardíaco), essa diferença no momento da avaliação das crianças entre as populações de estudo e controle pode ter se refletido nas taxas de MCM 2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17] . Devemos ressaltar também que a média de idade das mães à época do parto nesse estudo (34±4,9 anos) é mais elevada do que a das mães que concebem naturalmente, que é de 24,8 20 ou entre 27 e 28 anos 9 , fato observado na maioria dos trabalhos 2,16 .…”

“…Outros autores também estão de acordo com esses achados. Em um estudo foram encontrados cinco casos de malformação cardíaca em crianças de ICSI entre 16 MCM (31,2%) 11 . Outra avaliação encontrou 30 casos de malformações cardía-cas em de um total de 95 MCM (31,6%) 12 .…”

“…As preocupações quanto à segurança da ICSI estão relacionadas à técnica em si, à constituição genética do espermatozóide usado, além da possibilidade de imprinting genômico incompleto no momento da fertilização devido à utilização de espermatozói-des testiculares 5,6,9,10 . Trabalhos publicados não indicam aumento na incidência de malformações congênitas nas crianças nascidas de ICSI em comparação com a população geral 6,11,12 . No entanto, diferentes estudos referem aumento de alterações cromossômicas, especialmente as chamadas de novo: 3,3% (7/ 13 .…”

Two‐year neurodevelopmental outcome in children conceived by intracytoplasmic sperm injection: prospective cohort study

“…If only singletons were considered, the 10% incidence of prematurity in our study was comparable to the 6 -9% reported in the literature. 18,20,21 Increased prematurity among ICSI and other assisted reproductive technologies has been well documented 13,18,22,23 and possible causes attributed have been multiple births, PIH, bleeding during pregnancy and increased maternal age.…”