Hum. Reprod. Advance Access originally published online on December 2, 2004
Human Reproduction 2005 20(2):413-419; doi:10.1093/humrep/deh592
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A multi-centre cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception
1 Centrum Medische Gentica, Laarbeeklaan, 101, Brussels, Belgium, 2 Department of Obstetrics & Gynaecology, Sahlgrenska University Hospital, Goteborg, Sweden, 3 The Fertility Clinic, Rigshospitalet section 4071, Copenhagen University Hospital, Copenhagen, Denmark, 4 Infertility and IVF Center Geniki Kliniki, Thessaloniki, Greece, 5 Department of Primary Care and Population Sciences, Royal Free & University College Medical School, Rowland Hill Street, London, UK, 6 Department of Growth and Reproduction, Rigshospitalet section 5064, Copenhagen University Hospital, Copenhagen, Denmark and 7 Department of Child Health, Royal Free & University College Medical School, Rowland Hill Street, London, UK
8 To whom correspondence should be addressed at: Department of Child Health, Royal Free & University College Medical School, Royal Free Hospital, Lower Ground Floor, Pond Street, London, NW3 2PF, UK. Email: icsi{at}rfc.ucl.ac.uk
BACKGROUND: Over a million children have been born from assisted conception worldwide. Newer techniques being introduced appear less and less ‘natural’, such as intracytoplasmic sperm injection (ICSI), but there is little information on these children beyond the neonatal period. METHODS: 540 ICSI conceived 5-year-old children from five European countries were comprehensively assessed, along with 538 matched naturally conceived children and 437 children conceived with standard IVF. RESULTS: Of the 540 ICSI children examined, 63 (4.2%) had experienced a major congenital malformation. Compared with naturally conceived children, the odds of a major malformation were 2.77 (95% CI 1.41–5.46) for ICSI children and 1.80 (95% CI 0.85–3.81) for IVF children; these estimates were little affected by adjustment for socio-demographic factors. The higher rate observed in the ICSI group was due partially to an excess of malformations in the (boys') urogenital system. In addition, ICSI and IVF children were more likely than naturally conceived children to have had a significant childhood illness, to have had a surgical operation, to require medical therapy and to be admitted to hospital. A detailed physical examination revealed no further substantial differences between the groups, however. CONCLUSIONS: Singleton ICSI and IVF 5-year-olds are more likely to need health care resources than naturally conceived children. Assessment of singleton ICSI and IVF children at 5 years of age was generally reassuring, however, we found that ICSI children presented with more major congenital malformations and both ICSI and IVF children were more likely to need health care resources than naturally conceived children. Ongoing monitoring of these children is therefore required.
Key words: birth defects/ICSI/IVF
A.Sutcliffe and M.Bonduelle contributed equally to this study. A.Sutcliffe and M.Bonduelle conceived and designed the study. Final study protocol also had input from A.Loft, U.-B.Wennerholm, B.Tarlatzis and A.van Steirteghem. Drs C.Peters, S.Henriet, A.Victorin-Cederquist, C.Mau and A.Balaska did the data collection under the supervision of A.Sutcliffe, M.Bonduelle, U.-B.Wennerholm, A.Loft and B.Tarlatzis. J.Emberson did the statistical analysis with input from M.Bonduelle and U.-B.Wennerholm. A.Sutcliffe and M.Bonduelle wrote the report with input from U.-B.Wennerholm and A.Loft and the report was reviewed by the other researchers.
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