Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Hum Reprod. 2011 Jul;26(7):1759-67. doi: 10.1093/humrep/der136. Epub 2011 Apr 30.
To evaluate the safety of ICSI with epididymal sperm, this study compared children born after ICSI treatment with epididymal sperm and children conceived after IVF and ICSI with ejaculated sperm. Additionally, the results of a multidisciplinary, multicentre follow-up of the children conceived with epididymal sperm at 2 years of age are described.
This follow-up study included 378 children conceived after ICSI with epididymal sperm (percutaneous epididymal sperm aspiration: PESA group) and a control group of 1192 IVF and 1126 ICSI (with ejaculated sperm) children, all with a gestational age of 20 weeks or more. Questionnaires were sent at birth, 1 year and 4 years of age, collecting data on parental, pregnancy and child factors. A total of 148 PESA children were assessed at 2 years of age for motor performance, mental- and language development and compared with the Dutch norms.
PESA children showed no increased risks for stillbirths, total deaths and malformations. They also did not differ from IVF and ICSI children in gender rate, birthweight and gestational age. The mental Bayley score was higher (P < 0.05) for PESA singletons and parents reported fewer (P < 0.05) behavioural problems in the PESA group than the Dutch reference group. The scores for syntactic and lexical development for the PESA singletons were better (P < 0.05) than the Dutch standards.
ICSI with epididymal sperm does not lead to more stillbirths or congenital malformations in comparison to IVF and ICSI with ejaculated sperm and does not lead to poor development in comparison with the Dutch reference group.
为了评估使用附睾精子行卵胞浆内单精子注射（ICSI）的安全性，本研究比较了经附睾精子 ICSI 治疗后出生的婴儿、经体外受精（IVF）和 ICSI 联合射出精液治疗后出生的婴儿。此外，还描述了对经附睾精子行 ICSI 治疗后 2 岁时出生的儿童进行多学科、多中心随访的结果。
本随访研究纳入了 378 例经附睾精子 ICSI 治疗后（经皮附睾精子抽吸术：PESA 组）妊娠的婴儿和一个对照组（1192 例 IVF 和 1126 例 ICSI 联合射出精液治疗后妊娠的婴儿），所有婴儿的胎龄均≥20 周。在出生时、1 岁和 4 岁时发送问卷，收集父母、妊娠和儿童因素的数据。对 148 例 PESA 婴儿进行了 2 岁时的运动表现评估，并与荷兰标准进行了比较。
PESA 婴儿的死产、总死亡和畸形风险没有增加。与 IVF 和 ICSI 婴儿相比，PESA 婴儿的性别比例、出生体重和胎龄也没有差异。PESA 单胎的贝利精神发育指数得分较高（P<0.05），且父母报告的 PESA 组行为问题较少（P<0.05），比荷兰参考组好。PESA 单胎的句法和词汇发展评分也优于荷兰标准（P<0.05）。
与 IVF 和 ICSI 联合射出精液相比，使用附睾精子行 ICSI 并不会导致更多的死产或先天性畸形，与荷兰参考组相比也不会导致发育不良。
