Obstetric outcome of pregnancies following ICSI, classified according to sperm origin and quality

Abstract

The aim of this study was to report the outcome of all clinical pregnancies obtained after intracytoplasmic sperm injection (ICSI) performed during a 5 year period at two fertility clinics, with special reference to delivery outcome associated with different sperm origin and quality and the transfer of fresh or frozen-thawed pre-embryos. A total of 1293 clinical pregnancies was analysed. Deliveries occurred in 75.9% (n = 982) and early spontaneous abortion, late spontaneous abortion and ectopic pregnancy in 21.4, 1.0 and 1.2% respectively. Multiple birth occurred in 21.3% (208 sets of twins and one set of triplets) of the deliveries, with the highest incidence in the epididymal sperm group (30.2%) and lowest in the cryopreserved group (13.7%). A total of 1192 infants was born. Preterm birth occurred in 15.7% of all deliveries. Preterm birth was not related to sperm origin or quality but was related to multiple birth. The prematurity rate was 8.4%, 42.3% and 100% for singletons, twins and triplets respectively. Singleton infants born after cryopreservation as embryos had a significantly higher birthweight than the ejaculated sperm group with fresh embryo transfer. The perinatal mortality rate was 11.7 per 1000 born infants. Eighty-seven of the 1192 infants (7.3%) had a malformation, 40 of which were minor. The perinatal mortality rate and the malformation rate were similar in the different subgroups. Prenatal karyotyping was performed on 149 fetuses (12.5%) and abnormal results were found in four cases (2.7%). In conclusion, obstetric outcome of ICSI pregnancies was similar to that of conventional IVF and was not influenced by sperm origin or quality. The high incidence of multiple births is still the major concern.

Outcomes for offspring of men having ICSI for male factor infertility

“…A 2010 systematic review of five studies comparing the source of the sperm demonstrated no significant differences between the groupings in terms of risk for congenital malformations. 39 The range of frequencies of congenital malformations in ejaculated sperm was from 1.9% 40 to 8.4%, 41 for epididymal sperm from 2.0% 40 to 4.3% 42 and for testicular sperm from 0% 42 to 9.2%. 41 Within each study, there were no significant differences in risk of congenital malformations, although the range of frequencies reflects the inconsistencies mentioned earlier in regard to ascertainment of congenital malformations.…”

Male factor infertility and ART

“…87 Neither obstetric outcome of ICSI pregnancies nor child development of ICSI offspring was different from conventional IVF and not influenced by sperm origin or quality. 88,89 When epididymal sperm is used for ICSI, stillbirths or congenital malformations are not more prevalent in comparison to IVF and ICSI using ejaculated sperm, while cognitive development was also similar. 90,91 While aneuploidy screening on embryos obtained after ICSI for NOA showed increased aneuploidy and mosaicism, 92 and karyotypes of miscarriages occurring after TESE-ICSI showed higher aneuploidy rates than expected, 93 the few publications focusing on the outcome of children born after ICSI using testicular sperm conclude that no significant differences exist between ICSI using ejaculated spermatozoa or ICSI using testicular spermatozoa in terms of birth weight, perinatal mortality and major malformation rate.…”

Intracytoplasmic Sperm Injection – Factors Affecting Fertilization

“…After ICSI, ejaculated or surgically extracted sperm, when motile and morphologically normal, result in similar fertilization, implantation [108,109] and clinical pregnancy rates ( [109]. The incidence of early or late spontaneous abortion and ectopic pregnancy, or malformations is also similar [108].…”

“…After ICSI, ejaculated or surgically extracted sperm, when motile and morphologically normal, result in similar fertilization, implantation [108,109] and clinical pregnancy rates ( [109]. The incidence of early or late spontaneous abortion and ectopic pregnancy, or malformations is also similar [108]. However, after conventional IVF, even testicular or epididymal aspirates with very good sperm concentration and motility, generally achieve low fertilization and pregnancy rates [110].…”