MEDICAL AND DEVELOPMENTAL OUTCOME AT 1-YEAR FOR CHILDREN CONCEIVED BYINTRACYTOPLASMIC SPERM INJECTION

Background Intracytoplasmic sperm injection (ICSI) was introduced as a new form of in-vitro fertilisation (IVF) in 1993 and is now accepted as the treatment of choice for severe male infertility in many centres around the world. However, there is little information about the long -term outcome of children conceived by ICSI, We aimed to find out the medical and developmental outcome of children conceived by ICSI at age 1 year. Methods In this prospective study, we compared the medical an d developmental outcome at 1 year of 89 children conceived by ICSI wit h 84 children conceived by routine IVF, and with 80 children conceived naturally. Formal developmental assessment was done with Bayley Scale s of Infant Development (2nd edition) from which a mental development index (MDI) was derived. Findings There was no significant difference in the incidence of major congenital malformations or major health pro blems in the first year of life. However, the mean Bayley MDI was sign ificantly lower for the children conceived by ICSI than for the childr en conceived by routine IVF or naturally (95.9 [SD 10.7], 101.8 [8.5], and 102.5 [7.6], respectively, p<0.0001). 15 (17%) of 89 children con ceived by ICSI experienced mildly or significantly delayed development (MDI<85) at 1 year compared with two (2%) of the 84 children conceive d by IVF and one (1%) of the 80 children conceived by natural concepti on (p<0.0001). Interpretation Although most children conceived by ICSI are healthy and develop normally, there is an increased risk of mild delays in development at 1 year when compared with children conceived by routine IVF or conceived naturally. These findings support the need for ongoing developmental follow-up of children conceived by ICSI to see whether they are at increased risk of intellectual impairment or l earning difficulties at school age.