Assessing the safety of ICSI – A 16 year experience

Abstract

To assess the safety of a large series of ICSI cycles in oligo- and azoo-spermic men. In this study, we assessed the embryology, obstetrical and neonatal outcomes of conceptuses generated using surgically retrieved spermatozoa in comparison to ejaculated samples. ART cycles were classified according to the type of spermatozoa utilized (ejaculated versus surgically retrieved) as well as the insemination method. Malformations were considered major when surgery was required or had the ability to impair daily activity, while those that did not were considered minor. From 1993 to 2009, a total of 29,200 ART cycles were performed at our Center comprising of 10,373 standard IVF and 18,827 ICSI insemination. Ejaculated samples were used in 90.4% (ICSIe, n = 17,017) while surgically retrieved (ICSI-sr; n = 1810) were used in the remainder. The maternal ages of ICSIe and IVF were comparable (37 yrs) while ICSI-sr were younger (34.3 ± 5 yrs, P < 0.0001). The fertilization rate after ICSIe was 74.3%, ICSI-sr was 63.7%, and IVF was 60.3% (P = 0.0001). Clinical pregnancy after ICSI-sr (46.0%) was higher than ICSIe and IVF (37.6 and 39.8 %, respectively; P = 0.0001). Interestingly, the pregnancy losses was lower with ICSI-sr (8.9%) in comparison to the ICSIe (11.9%) and IVF (11.3%) (P = 0.04). ICSI-sr had a higher delivery rate (41.6%) than its ejaculated counterparts (33.0%; P = 0.0001). IVF had 37.7% of twins, triplets, quadruplets while ICSIe and –sr were 32.7 and 34.8%, respectively (P = 0.0001). No difference was observed in malformation rate between among the three cohorts, ICSIe at 1.4%, ICSI-sr at 1.2%, and IVF at 1.4%, mainly in multiple gestations. ICSI has become a routine insemination method with suboptimal spermatozoa or those surgically retrieved. Obstetrical and neonatal outcomes are reassuring despite of the genetic components of male factor infertility at least in singleton pregnancies.