Hershko-Klement A, Sukenik-Halevy R, Biron Shental T, Miller N, Berkovitz A
The Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel.
Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Andrology. 2016 Sep;4(5):887-93. doi: 10.1111/andr.12221. Epub 2016 Jun 17.
Our objective was to study the birth defect rates in intracytoplasmic morphologically selected sperm injection (IMSI) pregnancies. A cohort of couples presenting male factor infertility between January 2006 and January 2014 was retrospectively analyzed. Discharge letters and a telephone interview were performed for assessing pregnancy outcome. All clinical data were reviewed by a board certified medical geneticist. Main outcomes were fetal/birth defect and chromosomal abnormality rates. Two thousand two hundred and fifty-eight pregnancies were available for analysis, of them, 1669 (73.9%) resulting from ICSI and 2258 (26.1%) achieved by IMSI. Pregnancy outcome distribution did not show a significant difference. For the fresh embryo transfer cohort, fetal/birth defect rate was 4.5%, chromosomal aberration rate was 1.0%, and structural malformation rate was 3.5%. IMSI vs. ICSI pregnancies were less likely to involve a fetal/birth defect: 3.5% vs. 4.8%, respectively, but did not reach a statistical significance OR 0.71 (95% CI 0.39-1.22). Split by multiplicity, this trend existed only for singleton pregnancies; 1.4% structural malformations rate vs. 3.8%, respectively, OR 0.35 (95% CI 0.11-0.9). The frozen cohort demonstrated a significantly lower birth defect rate (OR 0.25, 95% CI 0.09-0.58). We conclude that IMSI procedure does not involve an increased malformation rate and may offer a reduced anomaly incidence. Further studies are required.
我们的目标是研究卵胞浆内形态学选择精子注射（IMSI）妊娠中的出生缺陷率。对2006年1月至2014年1月期间出现男性因素不育的夫妇队列进行回顾性分析。通过出院小结和电话访谈来评估妊娠结局。所有临床数据均由一名获得委员会认证的医学遗传学家进行审查。主要结局为胎儿/出生缺陷率和染色体异常率。共有2258例妊娠可供分析，其中1669例（73.9%）通过卵胞浆内单精子注射（ICSI）获得，2258例（26.1%）通过IMSI实现。妊娠结局分布未显示出显著差异。对于新鲜胚胎移植队列，胎儿/出生缺陷率为4.5%，染色体畸变率为1.0%，结构畸形率为3.5%。IMSI与ICSI妊娠相比，胎儿/出生缺陷的发生率较低：分别为3.5%和4.8%，但未达到统计学显著性，比值比为0.71（95%可信区间0.39 - 1.22）。按多胎情况划分，这种趋势仅存在于单胎妊娠中；结构畸形率分别为1.4%和3.8%，比值比为0.35（95%可信区间0.11 - 0.9）。冷冻胚胎移植队列的出生缺陷率显著较低（比值比0.25，95%可信区间0.09 - 0.58）。我们得出结论，IMSI操作不会增加畸形率，且可能降低异常发生率。需要进一步研究。
