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Hum. Reprod. Advance Access originally published online on January 15, 2007
Human Reproduction 2007 22(4):1080-1085; doi:10.1093/humrep/del488
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Malformation rate and sex ratio in 412 children conceived with epididymal or testicular sperm

Jens Fedder1,7, A. Gabrielsen2, P. Humaidan3, K. Erb4, E. Ernst5 and A. Loft6

1 The Fertility Clinic, Braedstrup Hospital, Braedstrup, Denmark 2 The Fertility Clinic, Ciconia, Aarhus, Denmark 3 The Fertility Clinic, Skive Hospital, Skive, Denmark 4 The Fertility Clinic, Odense Hospital, Odense, Denmark 5 The Fertility Clinic, Skejby Hospital, Aarhus, Denmark 6 Rigshospitalet, Copenhagen, Denmark

7 To whom correspondence should be addressed at: The Fertility Clinic, Braedstrup Hospital, DK-8740 Braedstrup, Denmark. Tel: +45 79591136; Fax: +45 79591139; E-mail: jfe{at}bs.vejleamt.dk/ fedder{at}dadlnet.dk

BACKGROUND: Follow-up studies of children conceived after ICSI using epididymal or testicular sperm are important due to a still more extensive use of immature male germ cells for ICSI. It is, however, difficult to evaluate the potential risks of malformations of children born after ICSI, overcoming the natural fertilization processes, due to methodological limitations.

METHODS: Follow-up study including all children born in Denmark and Norway following ICSI in Denmark, using epididymal or testicular sperm, was done. A questionnaire was sent to the parents between 3 months and 7 years after delivery.

RESULTS: Of 341 couples, 329 returned the questionnaire giving a response rate of 96.5%. The study included 412 children, 225 girls and 187 boys, giving a sex ratio (males/males + females) of 45.4% compared with 53.1% in Danish children conceived after conventional IVF without ICSI (P < 0.005). Among a total of 14 (3.4%; 95% confidence interval (CI): 1.9%–5.7%) major malformations, three boys with hypospadias were the most remarkable finding (1.6%; 95% CI: 0.33–4.7%).

CONCLUSIONS: An increased frequency of hypospadias in the male offsprings was seen compared with the general population. Apart from this, no increased major malformation rate was detected in ICSI children conceived with epididymal or testicular sperm when compared with malformation rates for IVF or spontaneously conceived children reported in the literature. The sex ratio was significantly lower for ICSI children conceived with epididymal or testicular sperm when compared with children conceived with conventional IVF.

Key words: cardiovascular defect/hypospadia/malformation/sex ratio/testicular sperm aspiration/percutaneous epididymal sperm aspiration follow-up

Submitted on June 7, 2006; resubmitted on October 13, 2006; resubmitted on November 21, 2006; accepted on November 29, 2006.


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