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December 18, 1996, Vol 276, No. 23 >
ARTICLE | December 18, 1996

Evolution of Pregnancies and Initial Follow-up of Newborns Delivered After Intracytoplasmic Sperm Injection FREE

Gianpiero D. Palermo, MD; Liliana T. Colombero, MD; Glenn L. Schattman, MD; Owen K. Davis, MD; Zev Rosenwaks, MD
[+] Author Affiliations

Reprints: Gianpiero D. Palermo, MD, The Center for Reproductive Medicine and Infertility, The New York Hospital-Cornell Medical Center, 505 E 70th St, HT-336, New York, NY 10021-4872 (e-mail: gdpalerm@ mail.med.cornell.edu).


JAMA. 1996;276(23):1893-1897. doi:10.1001/jama.1996.03540230043033
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References

Objective.  —To analyze the in vivo development of embryos conceived after intracytoplasmic sperm injection (ICSI), as well as obstetric outcome, occurrence of chromosomal abnormalities, and rate of congenital malformations in neonates born as a result of this treatment.

Design.  —Retrospective study.

Setting.  —University-based in vitro fertilization (IVF) clinic.

Patients.  —A total of 751 couples in whom the male partners were presumed to be the cause of repeated failed IVF attempts or whose semen parameters were unacceptable for conventional IVF treatment.

Interventions.  —Analysis of pregnancies resulting from 987 ICSI cycles; pregnancy outcome data were obtained from the records of obstetrician-gynecologists and/or pediatricians.

Main Outcome Measures.  —Pregnancy rates, obstetric outcome, and frequency of chromosomal abnormalities and congenital malformations.

Results.  —The overall clinical pregnancy (fetal heartbeat) rate was 44.3%, with a resultant delivery rate per ICSI cycle of 38.7% (n=382). In 8 of 11 miscarriages for which cytogenetic data were available, an autosomal trisomy was found, and 7 additional pregnancies were terminated because of a chromosomal abnormality after prenatal diagnosis. There was an equal distribution of vaginal vs cesarean deliveries (n=192 and n=190, respectively). Of the 578 neonates resulting from treatment by ICSI, 15 (2.6%) presented with congenital abnormalities (9 major and 6 minor abnormalities). However, this frequency of malformations is lower than that observed in offspring born after standard IVF at our institution. Furthermore, when pregnancy outcome of ICSI vs IVF was analyzed in terms of semen origin, no differences were found in the frequency of miscarriages or in the rate of congenital malformations.

Conclusions.  —The evolution of pregnancies and occurrence of congenital malformations following treatment by ICSI were within the range observed with standard in vitro fertilization.

REFERENCES

1 +
Palermo G, Joris H, Devroey P, Van Steirteghem AC.  Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte . Lancet . 1992;;340:17-18.
2 +
Palermo G, Joris H, Derde MP, Camus M, Devroey P, Van Steirteghem AC.  Sperm characteristics and outcome of human assisted fertilization by subzonal insemination and intracytoplasmic sperm injection . Fertil Steril . 1993;;59:826-835.
3 +
Van Steirteghem AC, Liu J, Joris H, et al.  Higher success rate by intracytoplasmic sperm injection than by subzonal insemination: report of a second series of 300 consecutive treatment cycles . Hum Reprod . 1993;;8:1055-1060.
4 +
Silber SJ, Nagy ZP, Liu J, Godoy H, Devroey P, Van Steirteghem AC.  Conventional IVF versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration . Hum Reprod . 1994;;9:1705-1709.
5 +
Schoysman R, Vanderzwalmen P, Nijs M, et al.  Pregnancy obtained with human testicular spermatozoa in an in vitro fertilization program . J Androl . 1994;;15( (suppl) ):10S-13S.
6 +
Bonduelle M, Desmyttere S, Buysse A, et al.  Prospective follow-up study of 55 children born after subzonal insemination and intracytoplasmic sperm injection . Hum Reprod . 1994;;9:1765-1769.
7 +
Bonduelle M, Hamberger L, Joris H, Tarlatzis BC, Van Steirteghem AC.  Assisted reproduction by intracytoplasmic sperm injection: an ESHRE survey of clinical experiences until December 1993 . Hum Reprod Update [serial on CD-ROM] . 1995;;1:3.
8 +
In't Veld P, Brandenburg H, Verhoeff A, Dhont A, Los F.  Sex chromosomal abnormalities and intracytoplasmic sperm injection . Lancet . 1995;;336:773.
9 +
De Jonge C, Pierce J.  Intracytoplasmic sperm injection: what kind of reproduction is being assisted? Hum Reprod . 1995;;10:2518-2520.
10 +
Patrizio P.  Intracytoplasmic sperm injection (ICSI): potential genetic concerns . Hum Reprod . 1995;;10:2520-2523.
11 +
Palermo G, Rosenwaks Z.  Assisted fertilization for male-factor infertility . Semin Reprod Endocrinol . 1995;;13:39-52.
12 +
Palermo GD, Cohen J, Rosenwaks Z.  Intracytoplasmic sperm injection: a powerful tool to overcome fertilization failure . Fertil Steril . 1996;;65:899-908.
13 +
Palermo GD, Cohen J, Alikani M, Adler A, Rosenwaks Z.  Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility . Fertil Steril . 1995;;63:1231-1240.
14 +
Palermo GD, Alikani M, Bertoli M, et al.  Oolemma characteristics in relation to survival and fertilization patterns of oocytes treated by ICSI . Hum Reprod . 1996;;11:172-176.
15 +
Cohen J, Alikani M, Adler A, et al.  Microsurgical fertilization procedures: absence of stringent criteria for a patient selection . J Assist Reprod Genet . 1992;;9:197-206.
16 +
Smith DW.  Classification, nomenclature and naming of morphological defects . J Pediatr . 1975;;87:162-164.
17 +
Holmes LB.  Congenital malformations . N Engl J Med . 1976;;295:204-207.
18 +
Medical Research International, Society for Assisted Reproductive Technology (SART), The American Fertility Society.  In-vitro fertilizationembryo transfer (IVF-ET) in the United States: 1990 results from the IVF-ET Registry . Fertil Steril . 1992;;57:15-24.
19 +
Wisanto A, Magnus M, Bonduelle M, et al.  Obstetric outcome of 424 pregnancies after intracytoplasmic sperm injection . Hum Reprod . 1995;;10:2713-2718.
20 +
Hassold T, Chiu D.  Maternal age-specific rates of numerical chromosome abnormalities with special reference to trisomy . Hum Genet . 1985;;70:11-17.
21 +
Warburton D, Kline J, Stein Z, Strobino B.  Cytogenetic abnormalities in spontaneous abortions of recognized conceptions . In: Porter IH, Willey A, eds. Perinatal Genetics: Diagnosis and Treatment . New York, NY: Academic Press; 1986;:133-148.
22 +
Munné S, Dailey T, Sultan KM, Grifo J, Cohen J.  The use of first polar bodies for preconception diagnosis of aneuploidy . Hum Reprod . 1995;;10:1014-1020.
23 +
Munné S, Alikani M, Tomkin G, Grifo J, Cohen J.  Embryo morphology, developmental rates and maternal age are correlated with chromosomal abnormalities . Fertil Steril . 1995;;64:382-391.
24 +
Liebaers I, Bonduelle M, Van Assche E, Devroey P, Van Steirteghem A.  Sex chromosomal abnormalities after intracytoplasmic sperm injection . Lancet . 1995;;346:1095.
25 +
Govaerts I, Englert Y, Vamos E, Rodesch F.  Sex chromosomal abnormalities after intracytoplasmic sperm injection . Lancet . 1995;;346:1096.
26 +
New York State Dept of Health. Congenital Malformations Registry: Annual Report . Albany: New York State Dept of Health; 1990;.
27 +
Bonduelle M, Legein J, Buysse A, Devrowy P, Van Steirteghem AC, Liebaers I.  Comparative follow-up study of 130 children born after ICSI and 130 children born after IVF . Hum Reprod . 1994;;9 ( (suppl 4) ):38.
28 +
Sclesselmann JJ.  How does one assess the risk of abnormalities from human in-vitro fertilization? Am J Obstet Gynecol . 1979;;135:135-148.
29 +
Biggers JD.  In vitro fertilization and embryo transfer in human beings . N Engl J Med . 1981;;304:336-342.
30 +
Lancaster P.  Congenital malformations after in-vitro fertilization . Lancet . 1987;;2:1511.
31 +
Tesarik J.  Sex chromosomal abnormalities after intracytoplasmic sperm injection . Lancet . 1995;;346:1096.
32 +
Svendsen TO, Jones D, Butler L, Muasher SJ.  The incidence of multiple gestations after in vitro fertilization is dependent on the number of embryos transferred and maternal age . Fertil Steril . 1996;;65:561-565.
33 +
Cohen J, Mayaux MJ, Guihard-Moscato ML.  Pregnancy outcomes after in vitro fertilization . Ann N Y Acad Sci . 1988;;541:1-6.
34 +
Doyle PE, Beral V, Botting B, Wale CJ.  Congenital malformations in twins in England and Wales . J Epidemiol Community Health . 1990;;45:43-48.
35 +
Ma K, Inglis JD, Sharkey A, et al.  A Y-chromosome gene family with RNA-binding protein homology: candidates for the azoospermia factor AZF controlling human spermatogenesis . Cell . 1993;;75:1287-1295.
36 +
Kobayashi K, Mizuno K, Hida A, et al.  PCR analysis of the Y chromosome long arm in azoospermic patients: evidence for a second locus required for spermatogenesis . Hum Mol Genet . 1994;;3:1965-1967.
37 +
Patrizio P, Asch RH, Handelin B, Silber SJ.  Aetiology of congenital absence of the vas deferens: genetic study of three generations . Hum Reprod . 1993;;8:215-220.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Palermo G, Joris H, Devroey P, Van Steirteghem AC.  Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte . Lancet . 1992;;340:17-18.
2 +
Palermo G, Joris H, Derde MP, Camus M, Devroey P, Van Steirteghem AC.  Sperm characteristics and outcome of human assisted fertilization by subzonal insemination and intracytoplasmic sperm injection . Fertil Steril . 1993;;59:826-835.
3 +
Van Steirteghem AC, Liu J, Joris H, et al.  Higher success rate by intracytoplasmic sperm injection than by subzonal insemination: report of a second series of 300 consecutive treatment cycles . Hum Reprod . 1993;;8:1055-1060.
4 +
Silber SJ, Nagy ZP, Liu J, Godoy H, Devroey P, Van Steirteghem AC.  Conventional IVF versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration . Hum Reprod . 1994;;9:1705-1709.
5 +
Schoysman R, Vanderzwalmen P, Nijs M, et al.  Pregnancy obtained with human testicular spermatozoa in an in vitro fertilization program . J Androl . 1994;;15( (suppl) ):10S-13S.
6 +
Bonduelle M, Desmyttere S, Buysse A, et al.  Prospective follow-up study of 55 children born after subzonal insemination and intracytoplasmic sperm injection . Hum Reprod . 1994;;9:1765-1769.
7 +
Bonduelle M, Hamberger L, Joris H, Tarlatzis BC, Van Steirteghem AC.  Assisted reproduction by intracytoplasmic sperm injection: an ESHRE survey of clinical experiences until December 1993 . Hum Reprod Update [serial on CD-ROM] . 1995;;1:3.
8 +
In't Veld P, Brandenburg H, Verhoeff A, Dhont A, Los F.  Sex chromosomal abnormalities and intracytoplasmic sperm injection . Lancet . 1995;;336:773.
9 +
De Jonge C, Pierce J.  Intracytoplasmic sperm injection: what kind of reproduction is being assisted? Hum Reprod . 1995;;10:2518-2520.
10 +
Patrizio P.  Intracytoplasmic sperm injection (ICSI): potential genetic concerns . Hum Reprod . 1995;;10:2520-2523.
11 +
Palermo G, Rosenwaks Z.  Assisted fertilization for male-factor infertility . Semin Reprod Endocrinol . 1995;;13:39-52.
12 +
Palermo GD, Cohen J, Rosenwaks Z.  Intracytoplasmic sperm injection: a powerful tool to overcome fertilization failure . Fertil Steril . 1996;;65:899-908.
13 +
Palermo GD, Cohen J, Alikani M, Adler A, Rosenwaks Z.  Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility . Fertil Steril . 1995;;63:1231-1240.
14 +
Palermo GD, Alikani M, Bertoli M, et al.  Oolemma characteristics in relation to survival and fertilization patterns of oocytes treated by ICSI . Hum Reprod . 1996;;11:172-176.
15 +
Cohen J, Alikani M, Adler A, et al.  Microsurgical fertilization procedures: absence of stringent criteria for a patient selection . J Assist Reprod Genet . 1992;;9:197-206.
16 +
Smith DW.  Classification, nomenclature and naming of morphological defects . J Pediatr . 1975;;87:162-164.
17 +
Holmes LB.  Congenital malformations . N Engl J Med . 1976;;295:204-207.
18 +
Medical Research International, Society for Assisted Reproductive Technology (SART), The American Fertility Society.  In-vitro fertilizationembryo transfer (IVF-ET) in the United States: 1990 results from the IVF-ET Registry . Fertil Steril . 1992;;57:15-24.
19 +
Wisanto A, Magnus M, Bonduelle M, et al.  Obstetric outcome of 424 pregnancies after intracytoplasmic sperm injection . Hum Reprod . 1995;;10:2713-2718.
20 +
Hassold T, Chiu D.  Maternal age-specific rates of numerical chromosome abnormalities with special reference to trisomy . Hum Genet . 1985;;70:11-17.
21 +
Warburton D, Kline J, Stein Z, Strobino B.  Cytogenetic abnormalities in spontaneous abortions of recognized conceptions . In: Porter IH, Willey A, eds. Perinatal Genetics: Diagnosis and Treatment . New York, NY: Academic Press; 1986;:133-148.
22 +
Munné S, Dailey T, Sultan KM, Grifo J, Cohen J.  The use of first polar bodies for preconception diagnosis of aneuploidy . Hum Reprod . 1995;;10:1014-1020.
23 +
Munné S, Alikani M, Tomkin G, Grifo J, Cohen J.  Embryo morphology, developmental rates and maternal age are correlated with chromosomal abnormalities . Fertil Steril . 1995;;64:382-391.
24 +
Liebaers I, Bonduelle M, Van Assche E, Devroey P, Van Steirteghem A.  Sex chromosomal abnormalities after intracytoplasmic sperm injection . Lancet . 1995;;346:1095.
25 +
Govaerts I, Englert Y, Vamos E, Rodesch F.  Sex chromosomal abnormalities after intracytoplasmic sperm injection . Lancet . 1995;;346:1096.
26 +
New York State Dept of Health. Congenital Malformations Registry: Annual Report . Albany: New York State Dept of Health; 1990;.
27 +
Bonduelle M, Legein J, Buysse A, Devrowy P, Van Steirteghem AC, Liebaers I.  Comparative follow-up study of 130 children born after ICSI and 130 children born after IVF . Hum Reprod . 1994;;9 ( (suppl 4) ):38.
28 +
Sclesselmann JJ.  How does one assess the risk of abnormalities from human in-vitro fertilization? Am J Obstet Gynecol . 1979;;135:135-148.
29 +
Biggers JD.  In vitro fertilization and embryo transfer in human beings . N Engl J Med . 1981;;304:336-342.
30 +
Lancaster P.  Congenital malformations after in-vitro fertilization . Lancet . 1987;;2:1511.
31 +
Tesarik J.  Sex chromosomal abnormalities after intracytoplasmic sperm injection . Lancet . 1995;;346:1096.
32 +
Svendsen TO, Jones D, Butler L, Muasher SJ.  The incidence of multiple gestations after in vitro fertilization is dependent on the number of embryos transferred and maternal age . Fertil Steril . 1996;;65:561-565.
33 +
Cohen J, Mayaux MJ, Guihard-Moscato ML.  Pregnancy outcomes after in vitro fertilization . Ann N Y Acad Sci . 1988;;541:1-6.
34 +
Doyle PE, Beral V, Botting B, Wale CJ.  Congenital malformations in twins in England and Wales . J Epidemiol Community Health . 1990;;45:43-48.
35 +
Ma K, Inglis JD, Sharkey A, et al.  A Y-chromosome gene family with RNA-binding protein homology: candidates for the azoospermia factor AZF controlling human spermatogenesis . Cell . 1993;;75:1287-1295.
36 +
Kobayashi K, Mizuno K, Hida A, et al.  PCR analysis of the Y chromosome long arm in azoospermic patients: evidence for a second locus required for spermatogenesis . Hum Mol Genet . 1994;;3:1965-1967.
37 +
Patrizio P, Asch RH, Handelin B, Silber SJ.  Aetiology of congenital absence of the vas deferens: genetic study of three generations . Hum Reprod . 1993;;8:215-220.

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