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Follow-up of children born after ICSI
A Van Steirteghem1, M Bonduelle, P Devroey
1Centre for Reproductive Medicine, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Belgium. Andre.VanSteirteghem@az.vub.ac.be
Insights
Assisted reproductive technology (ART) children show a slight increase in chromosomal abnormalities but no higher malformation rates than naturally conceived children. Further studies are needed for long-term outcomes.
Area of Science:
- Reproductive Medicine
- Genetics
- Pediatrics
Background:
- Comparing outcomes of assisted reproductive technology (ART) and naturally conceived children is complex due to patient characteristics and study limitations.
- Existing data on intracytoplasmic sperm injection (ICSI) fetal karyotypes show a slight increase in de-novo chromosomal abnormalities.
Purpose of the Study:
- To review the available data on the health and developmental outcomes of children conceived via ICSI.
- To identify potential complications and areas for future research in ART outcomes.
Main Methods:
- Review of existing literature and data on ICSI fetal karyotypes and liveborn ICSI children.
- Analysis of reported rates of chromosomal abnormalities, multiple pregnancies, and congenital malformations.
- Examination of limited follow-up studies on ICSI children's medical and developmental outcomes.
Main Results:
- ICSI is associated with a slight but significant increase in de-novo sex chromosomal aneuploidy and structural autosomal abnormalities.
- A substantial increase in multiple pregnancies (mean 40%) is a major complication of ART, with twins being most common.
- Overall data from large surveys do not indicate a higher rate of major or minor congenital malformations in ICSI children compared to naturally conceived children.
Conclusions:
- While ICSI shows a slight increase in certain chromosomal abnormalities and a high rate of multiple pregnancies, current data do not suggest an overall higher malformation rate compared to natural conception.
- Limited follow-up studies at 1-2 years show no obvious problems, but further matched cohort and case-control studies are essential for definitive conclusions on long-term outcomes.
Abstract:
The comparison of outcome of assisted reproductive technology (ART) children and naturally conceived children may be hampered by the difference in characteristics of the infertile patients such as age and genetic risks. Follow-up studies are further hampered by the type of neonatal surveillance protocol, the number of individuals lost to follow-up, the size of the cohort study, and the lack of standardization, for example to define major anomalies. The limited available data on ICSI fetal karyotypes reveal that, in comparison with a general neonatal population, there is: (i) a slight but significant increase in de-novo sex chromosomal aneuploidy (0.6% instead of 0.2%) and structural autosomal abnormalities (0.4% instead of 0.07%); and (ii) an increased number of inherited (mostly from the infertile father) structural aberrations. Available data indicate that in 8319 liveborn ICSI children, the mean percentage who do not originate from singleton pregnancies was 40% (range 32.6-60.8% according to centre). Most multiples are twins, but there are also 4.4% triplets (in one survey 13.2%). This substantial increase in multiple pregnancies must be considered the most important complication of ART. The different percentages of major and minor congenital malformations cannot be compared, but overall the data in large and reliable surveys does not indicate a higher rate of malformations in ICSI children than in naturally conceived children. To date, only three studies have examined the medical and developmental outcome of ICSI children at 1 and 2 years. These do not reveal obvious problems, but in future further comparison of matched cohorts of children and case-control studies are needed before final conclusions can be drawn.