EVOLUTION OF PREGNANCIES AND INITIAL FOLLOW-UP OF NEWBORNS DELIVERED AFTER INTRACYTOPLASMIC SPERM INJECTION

Objective.-To analyze the in vivo development of embryos conceived aft er intracytoplasmic sperm injection (ICSI), as well as obstetric outco me, occurrence of chromosomal abnormalities, and rate of congenital ma lformations in neonates born as a result of this treatment. Design.-Re trospective study. Setting.-University-based in vitro fertilization (I VF) clinic. Patients.-A total of 751 couples in whom the male partners were presumed to be the cause of repeated failed IVF attempts or whos e semen parameters were unacceptable for conventional IVF treatment. I nterventions.-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 r ates, obstetric outcome, and frequency of chromosomal abnormalities an d congenital malformations. Results.-The overall clinical pregnancy (f etal heartbeat) rate was 44.3%, with a resultant delivery rate per ICS I cycle of 38.7% (n=382). In 8 of 11 miscarriages for which cytogeneti c data were available, an autosomal trisomy was found, and 7 additiona l pregnancies were terminated because of a chromosomal abnormality aft er prenatal diagnosis. There was an equal distribution of vaginal vs c esarean deliveries (n=192 and n=190, respectively). Of the 578 neonate s resulting from treatment by ICSI, 15 (2.6%) presented with congenita l abnormalities (9 major and 6 minor abnormalities). However, this fre quency of malformations is lower than that observed in offspring born after standard IVF at our institution. Furthermore, when pregnancy out come of ICSI vs IVF was analyzed in terms of semen origin, no differen ces were found in the frequency of miscarriages or in the rate of cong enital malformations. Conclusions.-The evolution of pregnancies and oc currence of congenital malformations following treatment by ICSI were within the range observed with standard in vitro fertilization.