Obstetric outcome of 904 pregnancies after intracytoplasmic sperm injection.

The obstetric data of 904 consecutive pregnancies obtained after intracytoplasmic sperm injection (ICSI) using ejaculated spermatozoa (group I), epididymal spermatozoa (group II), testicular spermatozoa (group III) and after the replacement of frozen-thawed embryos (group IV) are described. In all, there were 785 pregnancies in group I, 37 pregnancies in group II, 30 pregnancies in group III and 52 pregnancies in group IV. A total of 24 pregnancies (2.5%) have so far been lost to follow-up. The incidence of pregnancy loss, i.e. subclinical pregnancies, clinical abortions and ectopic pregnancies were highest in group IV (61.4%). Early pregnancy loss in groups I, II and III were 21.9, 37.8 and 33.3% respectively. Prenatal diagnosis was performed in 64.4% of the clinical pregnancies: amniocentesis in 48.2% and chorionic villus sampling in 16.2%. The karyotypes were normal in 97.6% of the prenatal diagnoses and there were 1.2% de novo and 1.2% inherited chromosome aberrations. Pregnancy complications such as prematurity and low birthweight were related to pregnancy multiplicity. Perinatal mortality occurred in 15 babies (17.1 per thousand), including nine intrauterine fetal deaths after 25 weeks of gestation and six cases of mortality during the first 7 days after birth. There is no evidence that the technique of ICSI using sperm cells of different origins yielded a higher obstetric risk.