Survey on intracytoplasmic sperm injection: report from the ESHRE ICSI Task Force

Abstract

Intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility, since normal fertilization and ongoing pregnancies can be achieved with severely affected spermatozoa. Hence, the application of ICSI is rapidly expanding around the world, necessitating an accurate assessment of the efficacy and safety of this novel technique. The European Society of Human Reproduction and Embryology (ESHRE) Task Force is gathering data annually on the clinical results, the pregnancy outcome and the follow-up of children born after ICSI using ejaculated, epididymal and testicular spermatozoa, in order to be able to provide reliable information on these important issues. During the 3 years 1993-1995, the number of centres performing ICSI increased from 35 to 101, and the total number of ICSI cycles performed per year rose from 3157 to 23932. The incidence of oocytes damaged by the procedure remained low (<10%) and the fertilization rates obtained with ejaculated, epididymal and testicular spermatozoa in 1995 were 64, 62.5 and 52% respectively. Thus, approximately 90% of the couples had an embryo transfer and the viable pregnancy rate was 21% for ejaculated, 22% for epididymal and 19% for testicular spermatozoa (with 25-30% multiple pregnancies). Furthermore, 3149 transfers of frozen-thawed embryos were performed and 7-11% of them resulted in a viable pregnancy. The ICSI results were similar during this 3 year period, irrespective of the origin of the spermatozoa. The perinatal outcome of children born after ICSI was not different from those born after in-vitro fertilization (IVF) or natural conception, and was only affected by multiplicity. Moreover, the incidence of major or minor malformations was not increased, but the chromosomal, especially the sex-chromosomal, aberration rate was slightly elevated. To summarize, a very high success rate is obtained by ICSI independently of the source of the spermatozoa, verifying the superiority of ICSI over conventional IVF. The procedure seems to be safe, but further follow-up of the children is necessary in order to be able to assess its safety more accurately.

A Meta-Analysis of Controlled Studies Comparing Major Malformation Rates in IVF and ICSI Infants with Naturally Conceived Children

“…These included the annual reports from the large national registry maintained by the Society for Assisted Reproductive Technology in cooperation with the Centers for Disease Control in the United States and the Multi-National Cooperative Registry, operated through the European Society for Human Reproduction and Endocrinology. (26,27) From the 44 controlled studies retrieved for close analysis, we excluded studies without ascertainable control groups, studies which did not report malformations as an outcome, and studies which combined MM and minor malformations in a single metric.…”

The role of sperm aneuploidy as a predictor of the success of intracytoplasmic sperm injection?

“…This is of particular relevance in view of the potential effect that these abnormalities may have on ICSI offspring. The increase risk of inherited chromosomal abnormalities is now well-documented from both studies using retrospectively matched controls (Tarlatzis and Bili, 1998;Bonduelle et al, 1998) and a prospective controlled study (Aboulghar et al, 2001). However, Bonduelle et al demonstrated an increase not only in inherited (0.92 versus 0.47%), but also de-novo (1.66 versus 0.44%), abnormalities of which half were sex chromosomal (0.83 versus 0.19%).…”

Traitement de l’azoospermie obstructive par injection Intracytoplasmique d’un spermatozoïde

“…However, in a large comparative study in 2000 Wennerholm et al, [101] compared ICSI births with IVF births and found no increase in major malformations between these two groups, concluding that this increased rate of congenital malformations is not associated with sperm origin or quality but rather due to a higher rate of multiple births. In 1998, the European Society Human Fertilization and Embryology ICSI Task Force confirmed the findings of smaller studies, reporting an increased risk (2%) of chromosomal abnormalities in ICSI babies [87].…”

“…The next major study was conducted by the International collaborative study of ICSI child and family outcomes group over a five year period [87] and no differences in cognitive, neurological or socio-economic development were observed although they highlighted an increase in urogenital problems in males more recently. In 2004 a meta-analysis [68] found compared major malformations rates ranged from 1.1-9.7% in ICSI compared with 0-6.9% in spontaneously conceived infants.…”