Two‐year neurodevelopmental outcome in children conceived by intracytoplasmic sperm injection: prospective cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 112; no. 10; pp. 1376 - 1383
• Main Authors: Agarwal, Pratibha, Loh, Sheila Kia Ee, Lim, Sok Bee, Sriram, Bhavani, Daniel, Mary Lourdes, Yeo, Seow Heong, Heng, Derrick
• Format: Journal Article
• Language: English
• Published: Oxford, UK and Malden, USA Blackwell Science Ltd 01.10.2005; Blackwell; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Birth defects; Child, Preschool; Cohort Studies; Congenital Abnormalities - epidemiology; Developmental Disabilities - etiology; Female; Gynecology. Andrology. Obstetrics; Humans; Male; Medical sciences; Mental Disorders - etiology; Obstetrics; Pregnancy; Pregnancy Outcome; Prenatal development; Prevalence; Prospective Studies; Psychometrics; Reproductive technologies; Singapore - epidemiology; Sperm Injections, Intracytoplasmic - adverse effects; Singapore; Human; Prospective; Psychomotor development; Intracytoplasmic sperm injection; Cohort study; Gynecology; Assisted procreation; Child; Obstetrics
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2005.00663.x

Objective  Primary outcome was to compare neurodevelopmental outcome at two years in intracytoplasmic sperm injection (ICSI) conceived children versus matched controls. Secondary outcome was to determine incidence of major congenital malformations and study perinatal outcome. Design  Prospective cohort study. Setting  Tertiary care perinatal centre over a period of 13 months. Population  Seventy‐six ICSI conceived children and 261 matched controls selected by matching for maternal age, sex, date of delivery, race, plurality and parity. Methods  Mental Development Index (MDI) and Psychometric Development Index (PDI) of the Bayley's Scale of Development (BSID‐II) and Vineland Adaptive Behaviour Scale (VABS) were used to assess the neurodevelopmental and functional outcome. The congenital malformations were classified according to ICD‐9 code. Main outcome measures  Primary outcome measure—neurodevelopmental and functional outcomes. Secondary outcome measure—congenital malformations and perinatal outcomes. Results  Neurodevelopmental and functional outcome were comparable in both groups. The mean MDI score was 92 [16] versus 90 [14] in the study and control groups respectively. Fourteen (18.4%) in the ICSI group had MDI <85 compared with 87 (33%) controls (P= 0.002). On linear regression the MDI was independently affected by plurality (P= 0.001), maternal education and socio‐economic status (P= 0.01). The study group had a lower gestation (36 [3] vs 37.1 [2] weeks; P= 0.005) and a higher incidence of prematurity <34 weeks [19 (25%)] vs [31 (12%)] P= 0.012]. Six (7.9%) of the ICSI babies and seven (2.7%) of the controls had a major congenital malformation (P= 0.05). Conclusions  Children born by ICSI pregnancies did not have an adverse neurodevelopmental outcome. The incidence of major congenital malformations in ICSI needs further evaluation.