Incidence and perinatal outcome of multiple pregnancies after intracytoplasmic sperm injection compared to standard in vitro fertilization

Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis

OBJECTIVE

To conduct a meta-analysis of studies assessing the effect of IVF and intracytoplasmic sperm injection (ICSI) on birth defects.

DESIGN

Meta-analysis.

SETTING

Centers for reproductive care.

PATIENT(S)

Patients treated by IVF and/or ICSI.

INTERVENTION(S)

We identified all studies published by September 2011 with data related to birth defects in children conceived by IVF and/or ICSI compared with spontaneously conceived children, or birth defects in the children conceived by IVF compared with those by ICSI. Risk ratios from individual studies were pooled with the fixed and random effect models.

MAIN OUTCOME MEASURE(S)

Risk of birth defects in children conceived by IVF and/or ICSI.

RESULT(S)

Of 925 studies reviewed for eligibility, 802 were excluded after screening titles and abstracts, 67 were excluded for duplicated data, data unavailable, or inappropriate control group, 56 were included in the final analysis. Among the 56 studies, 46 studies had data on birth defects in children conceived by IVF and/or ICSI (124,468) compared with spontaneously conceived children. These studies provided a pooled risk estimation of 1.37 (95% confidence interval [CI]: 1.26-1.48), which is also evident in subgroup analysis. In addition, 24 studies had data on birth defects in children conceived by IVF (46,890) compared with those by ICSI (27,754), which provided an overall no risk difference.

CONCLUSION(S)

Children conceived by IVF and/or ICSI are at significantly increased risk for birth defects, and there is no risk difference between children conceived by IVF and/or ICSI.

Comparing intracytoplasmic sperm injection and in vitro fertilization in patients with single oocyte retrieval

OBJECTIVE

To compare the efficacy of intracytoplasmic sperm injection (ICSI) and conventional IVF in patients with favorable and poor sperm parameters in which only a single oocyte was available for insemination.

DESIGN

Retrospective analysis.

SETTING

University-affiliated IVF center.

PATIENT(S)

A total of 311 patients (425 cycles) who underwent either stimulated or spontaneous IVF cycles that resulted in single oocyte retrieval.

INTERVENTION(S)

The ICSI was indicated when fertilization failure was anticipated because of sperm quality or other confounding female factors.

MAIN OUTCOME MEASURE(S)

Fertilization rates and pregnancy rates (PRs) were analyzed according to the woman's age (< or =39 or >39 years), sperm quality, and mode of insemination.

RESULT(S)

In patients <39 years old with favorable semen quality, ICSI and standard insemination produced similar fertilization rates (67.1% vs. 75.0%) and PRs (0.0 vs. 8.2%). Conversely, in cases with apparent lower semen quality, ICSI gave a significantly higher fertilization rate (85.4% vs. 44.2%) but no significant difference in PRs (14.6% vs. 4.7%). In patients >39 years old and with favorable semen quality, ICSI and standard insemination produced similar fertilization rates (82.4% vs. 68.4%) and PRs (0.0 vs. 1.1%). The ICSI for lower semen quality, however, produced both higher fertilization rates (84.0% vs. 52%) and higher PRs (8.0% vs. 0).

CONCLUSION(S)

Our results suggest that in poorly responding patients, semen quality should remain the most important determinant when considering whether to perform ICSI. We have found that the values of 20 x 10(6)/mL and 35% motility are good predictors of success in such patients.

Birth defects in children conceived by ICSI compared with children conceived by other IVF-methods; a meta-analysis

BACKGROUND

Intracytoplasmic sperm injection (ICSI) is a method of assisted reproductive technology that involves the selection of a single sperm cell and the manual injection of this cell into the egg. The lack of relevant experimental studies, the nature of the technology involving non-natural selection of the fertilizing sperm, and possible damage to the egg have caused concern that ICSI could increase the risk of birth defects. Data from available cohort studies comparing ICSI with standard in vitro fertilization (IVF) should be combined to evaluate the risks involved with ICSI.

METHODS

We reviewed more than 2500 titles and abstracts containing keywords related to ICSI and identified 22 scientific articles with data on birth defects among ICSI-births. A total of four peer-reviewed, non-overlapping prospective cohort studies provided reliable and comparable data on birth defects both for children conceived by ICSI and children conceived by standard IVF. These studies included a total of 5395 children born after ICSI.

RESULTS

The pooled estimate of the risk of a major birth defect was a 1.12-fold increase after ICSI when compared with standard IVF (risk ratio = 1.12, 95% confidence interval (CI): 0.97-1.28, P = 0.12). There was no marked heterogeneity of risk ratios between these studies (P = 0.10). We found no significantly increased risks after ICSI for any of the categories cardiovascular defects, musculoskeletal defects, hypospadias, neural tube defects, or oral clefts.

CONCLUSIONS

Our analysis does not indicate that the ICSI-procedure represents significant additional risks of major birth defects in addition to the risk involved in standard IVF. The data was limited, particularly on risks of specific categories of defects.

The economic consequences of multiple gestation pregnancy in assisted conception cycles

This study estimates the projected costs of multiple births resulting from assisted conception cycles (in vitro fertilization with or without intracytoplasmic sperm injection and ovarian stimulation with gonadotrophin). The estimates are modelled from the volume of services, treatment success and multiple gestation rates in recent registry data. The coverage is restricted to hospital costs associated with delivery and the trends are projected to 2000 in the United States. Sensitivity analyses tested different assumptions about per annum trends in effectiveness, multiple pregnancy rates and health costs. The national cost of in vitro fertilization cycles is US$470.2 million (£313.5 million) and the cost of the multiple pregnancies from in vitro fertilization is US$639.9 million (£426.7 million). The national cost of ovarian stimulation cycles is US$166.6 million (£111.1 million) and the cost of the multiple pregnancies from ovarian stimulation is US$257.3 million (£171.6 million). Although costs are a limited indicator of the burden of illness, the projected national cost of multiple pregnancy associated with assisted conception in 2000 is greater than the base cost of the treatment. Prevention of multiple pregnancy in assisted conception cycles should be a priority.

Descriptive studies: what they can and cannot do

Descriptive studies often represent the first scientific toe in the water in new areas of inquiry. A fundamental element of descriptive reporting is a clear, specific, and measurable definition of the disease or condition in question. Like newspapers, good descriptive reporting answers the five basic W questions: who, what, why, when, where. and a sixth: so what? Case reports, case-series reports, cross-sectional studies, and surveillance studies deal with individuals, whereas ecological correlational studies examine populations. The case report is the least-publishable unit in medical literature. Case-series reports aggregate individual cases in one publication. Clustering of unusual cases in a short period often heralds a new epidemic, as happened with AIDS. Cross-sectional (prevalence) studies describe the health of populations. Surveillance can be thought of as watchfulness over a community; feedback to those who need to know is an integral component of surveillance. Ecological correlational studies look for associations between exposures and outcomes in populations-eg, per capita cigarette sales and rates of coronary artery disease-rather than in individuals. Three important uses of descriptive studies include trend analysis, health-care planning, and hypothesis generation. A frequent error in reports of descriptive studies is overstepping the data: studies without a comparison group allow no inferences to be drawn about associations, causal or otherwise. Hypotheses about causation from descriptive studies are often tested in rigorous analytical studies.