P-764 Is children’s health up to two years of age affected by embryo vitrification?

Study question

Does embryo vitrification affect children’s health including growth, up to 2 years of age when compared to fresh embryo transfer?

Summary answer

While embryo vitrification had an impact on birth parameters, no differences in growth or health outcomes were found up to 2 years of age.

What is known already

Vitrification has become the preferred cryopreservation method for embryos. Frozen embryo transfer has been repeatedly associated with altered health outcomes when compared with fresh transfer including a decreased risk for small-for gestational age (SGA) and an increased risk for large-for-gestational-age (LGA) and macrosomia. Not only there is uncertainty which factors are responsible for the observed differences, also the heterogeneity among studies limits overall conclusions.

Notwithstanding the observed differences at birth, little is known about growth and health of children born after embryo vitrification beyond birth while aberrant growth trajectories have been linked to cardiometabolic morbidity later in life.

Study design, size, duration

This single-center cohort study compared anthropometry and health outcomes in singletons conceived after cleavage-stage or blastocyst-stage embryo vitrification with results after fresh embryo transfer between 2014 and 2018. Pregnancies after PGT, IVM, oocyte vitrification or oocyte/embryo donation were excluded.

Eligible singletons living in Belgium and randomly selected for continued follow-up were invited for examination in our center at 2 months (infancy) and 2 years of age (early childhood).

Participants/materials, setting, methods

Birth characteristics were available for 1237 and 2063 children born after embryo vitrification and fresh embryo transfer, respectively. Follow-up data were available for 582 and 757 children at 2 months and for 233 and 296 children at 2 years.

Growth parameters were adjusted for neonatal, treatment and maternal characteristics. Subgroup analysis according to cycle regimen (HRT versus NC) and strategy (freeze-all versus previous fresh cycle) was performed. In addition, outcomes restricted to blastocysts are presented.

Main results and the role of chance

Mothers giving birth to a child conceived after embryo vitrification presented more often with pregnancy-induced hypertensive disorders than controls (P < 0.001).

Birthweight, height and head circumference SDS of children born after embryo vitrification were higher than for children born after fresh embryo transfer (all P < 0.001) even after adjustment for neonatal, treatment and maternal characteristics. Embryo vitrification was also associated with a decreased risk of SGA (AOR 0.48; 0.00, 0.44) and an increased risk of macrosomia and LGA (AOR 3.59; 1.12, 11.59)(all P < 0.05).

Restricting the sample to blastocysts (n = 1795), we found a higher birthweight SDS and increased risks of LGA, macrosomia and pregnancy-induced hypertensive disorders after vitrification (all P < 0.05).

At infancy, weight and height SDS were larger for children born after embryo vitrification, but not after adjustment for co-variates. At childhood, no differences in anthropometrics were found between the groups. Weight and height gain from birth to infancy and from infancy to early childhood were comparable between the groups. Until 2 years, comparable rates of severe developmental problems, hospital admissions, surgical interventions and of chronic medication intake were found between the groups.

Subgroup analysis showed that growth parameters at all ages were not affected by cycle regimen or cycle strategy.

Limitations, reasons for caution

Participation rate at 2 years was lower than expected in both groups, probably due to cancellation/postponement of the visit related to the corona pandemic.

Furthermore, although cycle strategy was not found to affect growth parameters, the sample size of the subgroup analysis remains rather small to draw firm conclusions.

Wider implications of the findings

When adjusted for co-variates including birthweight, the observed differences in anthropometrics at birth in children born after embryo vitrification attenuated by 2 years of age. This suggests that outcomes in early childhood are determined by size at birth.

Trial registration number

Not applicable

Chromosomal abnormalities after ICSI in relation to semen parameters: results in 1114 fetuses and 1391 neonates from a single center

STUDY QUESTION

Is there a relationship between karyotype abnormalities in fetuses and children conceived by ICSI and their father's semen parameters?

SUMMARY ANSWER

The de novo chromosomal abnormality rate in pre- and postnatal karyotypes of ICSI offspring was higher than in the general population and related to fathers' sperm parameters.

WHAT IS KNOWN ALREADY

Several studies have reported a higher rate of de novo chromosomal anomalies in ICSI fetuses but recent data from large cohorts are limited. Overall, reported prevalences of non-inherited karyotype aberrations are increased in fetuses conceived after ICSI and vary between 1.6% and 4.2%. Only a few studies focus on the relation between karyotype anomalies in ICSI offspring and semen parameters of their fathers. Furthermore, an increased incidence of abnormal karyotypes in ICSI neonates has been described, but the rates vary widely across studies.

STUDY DESIGN, SIZE, DURATION

We report on karyotype results from prenatal testing by means of chorionic villus sampling and amniocentesis and results from postnatal blood sampling in offspring conceived by ICSI in a single center. Ongoing pregnancies resulting from an oocyte retrieval between January 2004 and December 2012 and after transfer of fresh ICSI embryos obtained using ejaculated or non-ejaculated sperm (fresh or frozen-thawed) were considered. Pregnancies following frozen embryo transfer, oocyte or sperm donation, IVF, preimplantation genetic testing and IVM were excluded. All abnormal prenatal results after sampling are reported irrespective of the outcome of the pregnancy.

PARTICIPANTS/MATERIALS, SETTING, METHODS

From the 4816 ongoing ICSI pregnancies, information on pregnancy outcome was available for 4267 pregnancies. Prenatal testing was performed in 22.3% of the pregnancies, resulting in a diagnosis in 1114 fetuses. A postnatal karyotype was obtained in 29.4% of the pregnancies in which no invasive prenatal diagnosis was performed, resulting in a total of 1391 neonates sampled. The prevalence of chromosomal anomalies according to maternal age and semen quality was analyzed with logistic regression. For definitions of normal semen quality, the World Health Organization reference values for human semen characteristics were adopted.

MAIN RESULTS AND THE ROLE OF CHANCE

An abnormal fetal karyotype was found in 29 singletons and 12 multiples (41/1114; 3.7%; 95% CI 2.7-4.9%): 36 anomalies were de novo (3.2%; 95% CI 2.3-4.4), either numerical (n = 25), sex (n = 6) or structural (n = 5), and five were inherited. Logistic regression analysis did not show a significant association between maternal age and a de novo chromosomal fetal abnormality (odds ratio (OR) 1.05; 95% CI 0.96-1.15; P = 0.24). In all but one case, fetuses with an abnormal karyotype were conceived by ICSI using ejaculated sperm.Abnormal karyotypes were found in 14 (1.0%; 95% CI 0.6-1.7) out of 1391 postnatal samples of children born after ICSI who were not tested prenatally: 12 were de novo anomalies and two were inherited balanced karyotypes. The 14 abnormal karyotypes were all found in children born after ICSI using ejaculated sperm.The odds of a de novo karyotype aberration increased with maternal age when combining pre- and postnatal data (OR 1.11; 95% CI 1.04-1.19). A higher rate of de novo chromosomal abnormalities was found in fetuses and children of couples with men having a sperm concentration <15 million/ml (adjusted OR (AOR) 2.10; 95% CI 1.14-3.78), sperm concentration <5 million/ml (AOR 1.9; 95% CI 1.05-3.45) and total sperm count <10 million (AOR 1.97; 95% CI 1.04-3.74).

LIMITATIONS, REASONS FOR CAUTION

We cannot exclude that the observation of a higher prevalence of karyotype anomalies in ICSI offspring compared to literature data in the general population is due to enhanced surveillance after ART given the lack of a control group. Although we did not find more chromosomal anomalies after ICSI with non-ejaculated sperm, the small numbers do not allow firm conclusions.

WIDER IMPLICATIONS OF THE FINDINGS

The observed increased risk of a de novo karyotype anomaly after ICSI conception in couples with poor sperm warrants continued counseling toward prenatal testing.The current and widespread use of innovative non-invasive prenatal testing will result in larger datasets, adding to a balanced estimation of the prevalence of karyotype anomalies in ICSI offspring.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the Methusalem grants issued by the Vrije Universiteit Brussel. All authors declared no conflict of interest related to this study.

TRIAL REGISTRATION NUMBER

N/A.

Preimplantation genetic testing with HLA matching: from counseling to birth and beyond

Preimplantation genetic testing-human leukocyte antigen '(PGT-HLA) only' refers to the HLA typing of single or few cells biopsied from in vitro fertilized preimplantation embryos. The aim of the procedure is to establish a pregnancy, in which the fetus is HLA compatible with an affected sibling in need of a hematopoietic stem cell transplantation (HSCT). During PGT-M-HLA, the identification of a HLA-compatible embryo is combined with the detection of mutation(s) underlying immunodeficiencies and hemoglobinopathies. We report a combined retrospective and prospective cohort analysis of PGT-(M-)HLA procedures carried out from 1998 until 2017, with follow-up of transplantations to 2019. During the study period, 234 couples from 22 countries were invited for a multidisciplinary consultation. Two couples were rejected and 70 couples declined (various reasons), leaving 162 couples for which 414 clinical cycles were carried out. Cleavage stage biopsy followed by single-cell multiplex PCR for short tandem repeat-based haplotyping was applied in most cases (98.7%). The diagnostic efficiency was high (94.8%) but only 16.5% of the embryos was genetically suitable for transfer. Fresh and frozen-thawed embryo transfer resulted in 67 clinical pregnancies, 63 deliveries, and 74 live births, of which 60 children were HLA compatible. This yielded a live birth delivery rate of 30.3% per transfer. Information on neonatal characteristics of the matching PGT-(M-)HLA children showed reassuring outcomes. So far, HSCT was carried out successfully for 25 out of 26 cases. In conclusion, our data show that PGT-(M-)HLA is a valuable procedure: the high complexity and limited delivery rate are balanced by the successful HSCT outcome and the positive impact on families.

Family Communication About the Donor Conception: A Multi-Perspective Qualitative Study With Lesbian Parents and Their Children

In literature, disclosure of donor conception in lesbian families has been considered an obvious and straightforward event. However, little is known about the ways in which donor conception is discussed in planned lesbian co-mother families. This study focuses on the process of parent-child communication about the donor conception on a within-family level. Six families, including 7 children and 12 parents, were interviewed about their family communication with regard to donor conception. A dyadic interview analysis revealed that family members managed the space taken up by the topic of donor conception in their daily conversations. Within these conversations, they also took care of each other and of their family relationships. In addition, children had an active position in the co-construction of the donor conception narrative. Linking these findings to the concepts of relational management and functionality of donor conception narratives, this study informs practitioners in the field of medically assisted reproduction.

Two mothers and a donor: exploration of children's family concepts in lesbian households

BACKGROUND

Although children from lesbian families appear to make a distinction between a residential father and a donor, defining these two concepts seems to be a challenge. They need to appeal to more familiar concepts such as the hetero-normative concept of 'mother' to give a definition of the unfamiliar concepts they are confronted with.

METHODS

The study is based on qualitative in-depth interviews with 6 children (9-10 years old) from lesbian families, all of which have been conceived using anonymous sperm donation. Semi-structured interviews were conducted.

RESULTS

Two findings stand out. First, in defining the concepts of biological and non-biological mother, both mothers were described as equal parents. No difference was attached by the children to the mothers' position as a parent. Second, the concepts 'non-biological mother' and 'donor' were defined by looking at the hetero-normative concepts of 'mummy' and 'daddy'. To define the non-biological mother, both a 'mummy' and a 'daddy' were used as a reference. To define the donor concept, often references were made to a daddy. This comparison with a 'daddy' turned out to be complex due to the conflict between the role as a progenitor and the lack of a social relationship. The lack of language surrounding this concept turned out to be difficult.

WIDER IMPLICATIONS OF THE FINDINGS

This study illustrates the complexity and ambiguity of children's experiences and perceptions when dealing with issues related to genetic and social parenthood.

Sexual and relational satisfaction in couples where the woman has polycystic ovary syndrome: a dyadic analysis

STUDY QUESTION

How are objective characteristics of polycystic ovary syndrome (PCOS) and PCOS-related concerns associated with the sexual and relational satisfaction of PCOS women and their partners?

SUMMARY ANSWER

Both objective PCOS characteristics (parity, women's body mass index (BMI) and current unfulfilled wish to conceive) and PCOS-related concerns (women's infertility-related and acne-related concerns) were associated with sexual and/or relational satisfaction, although some associations differed for PCOS women and their partners.

WHAT IS KNOWN ALREADY

There is some evidence indicating an association between objective PCOS characteristics and sexual satisfaction of PCOS women, but this evidence is conflicting, scarce, and often validated questionnaires have not been used to evaluate sexual satisfaction. No evidence is available about the association of: (i) PCOS with relational satisfaction; (ii) PCOS-related concerns with sexual and relational satisfaction; and (iii) PCOS with sexual and relational satisfaction as experienced by partners of PCOS women.

STUDY DESIGN, SIZE, DURATION

We set up a cross-sectional study from April 2007 until April 2009, including 31 overweight (BMI ≥ 25 kg/m(2)) women with PCOS and at a reproductive age as well as their partners with whom they had a committed intimate relationship at the time of recruitment.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study was performed at the fertility center of the Ghent University Hospital. Objective PCOS characteristics were registered and PCOS-related concerns were evaluated by the PCOS Questionnaire. Sexual (SS) and relational (RS) satisfaction were measured by the Maudsley Marital Questionnaire (MMQ). Dyadic statistical analyses were performed using linear mixed models (α < 0.05).

MAIN RESULTS AND THE ROLE OF CHANCE

A lower parity tended to be associated with higher levels of sexual and relational satisfaction, with a significantly stronger association in PCOS women than in their partners (p(SS) = 0.015 and p(RS) = 0.009). A higher BMI tended to be associated with lower and higher satisfaction levels (sexual and relational) in PCOS women and their partners, respectively, with a significantly stronger association in the partners (p(SS) = 0.029 and p(RS) = 0.021). The presence of a current unfulfilled wish to conceive and a higher level of infertility-related concerns was significantly more strongly associated with a higher level of relational satisfaction for PCOS women than for their partners (p(RS) = 0.021 and p(RS) = 0.011, respectively). Higher levels of acne-related concern were significantly associated with lower levels of sexual satisfaction in both PCOS women (p(SS) = 0.025) and their partners (p(SS) = 0.002).

LIMITATIONS, REASONS FOR CAUTION

The fact that this study was performed in a sample of PCOS women who were all overweight and the small sample size are important limitations. Data were partially missing in some couples but this limitation was dealt with by using linear mixed models.

WIDER IMPLICATIONS OF THE FINDINGS

Our results suggest a differential association of PCOS with sexual and relational satisfaction between PCOS women and their partners. This should be kept in mind during the psychological guidance of couples dealing with PCOS.

STUDY FUNDING/COMPETING INTERESTS

V.D.F. is holder of a Special PhD Fellowship of the Flemish Foundation for Scientific Research (FWO-Vlaanderen). P.D.S. is holder of a fundamental clinical research mandate of the Flemish Foundation for Scientific Research (FWO-Vlaanderen). This research also received financial support by Merck Serono and Artevelde University College Ghent. There are no competing interests.

Lesbian couples' views about and experiences of not being able to choose their sperm donor

In this qualitative study, we explore how lesbian recipients view and experience the selection of their anonymous sperm donor. The study was conducted in Belgium, where fertility centres follow a legal protocol that severely restricts personal choice in donor selection. While previous studies have shown that recipients want greater control and input in the selection of their sperm donor, this was not a main concern for most women in the present study. They generally acknowledged their lack of control on the selection outcome and accepted this as part and parcel of an anonymous donation policy that provides an opportunity to have a child. They actively and passively downplayed initial concerns about the donor selection procedure and felt they did not have or need a right to further control over the donor selection. In adopting this 'subordinate' position, they felt they should trust the hospital, which they hoped would fulfil rather high screening standards. Those who did want more choice were nuanced and careful about their motivations: they focused on selecting traits that would facilitate normal child development or increase family coherence. The findings shed light on how these patients perceive their position in this third-party reproduction setting.

Beyond sperm cells: a qualitative study on constructed meanings of the sperm donor in lesbian families

STUDY QUESTION

What meanings do lesbian couples construct regarding their sperm donor?

SUMMARY ANSWER

For some parents, the donor was increasingly presented as a person, whereas for other parents, the donor was seen as an instrument from the moment they received the sperm donation.

WHAT IS KNOWN ALREADY

Few studies specifically focus on how lesbian couples deal with the issue of third-party anonymous gamete donation. It is often assumed that they have fewer difficulties than heterosexual couples with the involvement of a male procreator, since their status as a donor conception family is 'socially visible' and there is no social father who fears exclusion.

STUDY DESIGN, SIZE, DURATION

Semi-structured interviews were conducted with 10 lesbian couples (20 participants), recruited via the Ghent University Hospital. All couples had at least one child, conceived through anonymous donor insemination, between 7 and 10 years old.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Within the data corpus, a particular data set was analyzed where couples referred to their donor and his position in their family. Step-by-step inductive thematic analysis was performed resulting in themes that are grounded in the data. All phases of the analysis were followed by team discussion.

MAIN RESULTS AND THE ROLE OF CHANCE

This study reveals different donor constructs, indicating different ways of dealing with the third-party involvement in the family. Some parents diminish the role of the donor throughout family life and continue to present him as an instrument: something they needed in order to become parents. Others show an increasing interest in the donor as the children mature, which results in a more personalized account of the donor.

LIMITATIONS, REASONS FOR CAUTION

In our qualitative cross-sectional study, we collected retrospectively constructed stories. Longitudinal qualitative and quantitative research is required to allow for an extrapolation of the conclusions made.

WIDER IMPLICATIONS OF THE FINDINGS

This study shows how the concept of the donor is constructed within lesbian families and how it is challenged by the child's developing personality and features. When counseling prospective parents, it could therefore be useful to discuss the concept of the anonymous donor beyond the conception phase.

STUDY FUNDING/COMPETING INTEREST(S)

The project was funded by the Research Fund of Ghent University, Belgium. There are no competing interests.

The effects of parental presence upon the facial expression of pain: the moderating role of child pain catastrophizing

This experiment investigated the effects of child catastrophic thinking and parental presence on the facial expressions of children when experiencing pain. School children experienced pressure pain in either one of two conditions: (1) when observed by a parent (n=53 children and their parent), or (2) when observed by an adult stranger (n=31 children). Analyses revealed that children showed more facial pain expression in the presence of their parent than in the presence of the stranger. This effect was, however, only found for children with infrequent catastrophic thoughts about pain. Children who have frequent catastrophic thoughts expressed high pain regardless of who they believed was observing them. Results are discussed in terms of the social consequences of pain catastrophizing, and the variables contributing to the expression or suppression of pain display in children and its impact upon others.

Expressive dimensions of pain catastrophizing: a comparative analysis of school children and children with clinical pain

We investigated the role of the child's pain catastrophizing in explaining (1) children's self-reported tendency to verbally share their pain experience with others and (2) different dimensions of pain expression, as described by the mother and the father, including non-verbal and verbal communicative pain behaviour and protective pain behaviour. Participants were school children, children with chronic or recurrent pain, and their parents. The results showed that: (1) Pain catastrophizing was associated with children's greater self-acknowledged tendency to verbally share their pain experience with others. (2) Mothers and fathers perceived highly catastrophizing children to be more communicative about their pain. (3) The role of pain catastrophizing in the child's verbal sharing of pain experiences and in explaining expressive behaviour as rated by parents did not differ between the school children and children with recurrent and chronic pain. (4) Nevertheless, findings indicated marked differences between school children and the clinical sample. Children of the clinical sample experienced more severe pain, more pain catastrophizing, more protective pain behaviour, but less verbal communications about their pain. These results further corroborate the position that catastrophic thoughts about pain have interpersonal consequences. Findings are discussed in terms of the possible functions and effects upon others of pain catastrophizing and associated categories of pain behaviour.

Behavioural problems, social competence and self-concept in siblings of children with autism

INTRODUCTION

This study investigated the psychological adjustment of siblings of children with high-functioning autism (HFA) in comparison with siblings of normally developing children in the domain of behavioural problems, social competence and self-concept.

METHOD

Twenty-nine siblings of children with HFA and 29 siblings of children without a disorder participated in the study. Standardized, written questionnaires were used.

RESULTS

Siblings of children with HFA, especially brothers and sisters between 6 and 11 years old, had more behavioural problems than siblings of the control group. Sisters of children with HFA ascribed higher social competence to themselves. Sisters of children with HFA between 12 and 16 years old had a more positive self-concept. In both groups siblings with a more negative self-concept had less social skills and siblings with a more positive self-concept scored better in the social domain. Finally, in accordance with the control group, the perception of the siblings' social competence of parents of children with HFA broadly matched the perception siblings had of themselves.

DISCUSSION

Overall, siblings of children with HFA are not more susceptible to adaptation problems than siblings of children without a disorder. Implications for practice and further research are discussed.

Metacognition and mathematical problem solving in grade 3

This article presents an overview of two studies that examined the relationship between metacognition and mathematical problem solving in 165 children with average intelligence in Grade 3 in order to help teachers and therapists gain a better understanding of contributors to successful mathematical performance. Principal components analysis on metacognition revealed that three metacognitive components (global metacognition, off-line metacognition, and attribution to effort) explained 66% to 67% of the common variance. The findings from these studies support the use of the assessment of off-line metacognition (essentially prediction and evaluation) to differentiate between average and above-average mathematical problem solvers and between students with a severe or moderate specific mathematics learning disability.

VIDANN: a video annotation system

VIDANN is a computer program that allows participants to watch a video on a standard TV and to write their annotations (thought/feeling entries) on paper attached to a writing tablet. The system is designed as a Microsoft ActiveX module. It can be further adapted by the individual researcher through the use of a VBScript. All data, including the participant's handwriting, are stored in an XML database. An accompanying Wizard has been designed that enables researchers to generate VBScripts for standard configurations.

Advancing advanced mind-reading tests: empathic accuracy in adults with a pervasive developmental disorder

Research using advanced but static mind-reading tests with high-functioning adults with a pervasive developmental disorder (PDD) provided evidence for subtle social cognitive deficits. In the present study, adults with PDD were unimpaired on such tasks, relative to individually matched normal controls. Significant differences between the two groups were, however, found on a more naturalistic empathic accuracy task developed for this study. Participants viewed two videotaped interactions that both depicted a male and female stranger having an initial conversation and were asked to infer the unexpressed thoughts and feelings of the four targets. Subjects with PDD performed significantly worse on the second video. These findings suggest that the mind-reading deficit of a subgroup of able adults with PDD may only be apparent when a sufficiently complex naturalistic assessment method is being used.

Stimulation seeking and hyperactivity in children with ADHD. Attention Deficit Hyperactivity Disorder

Thirty hyperactive and 30 non-hyperactive children were confronted with a delay, consisting of a waiting situation of 15 minutes, either with or without extra stimulation provided by the presentation of a videotape. The behaviour of the child during the waiting period was videotaped and later coded by two naive observers. In line with theories that emphasise the stimulation-seeking function of hyperactive behaviours, such as the optimal stimulation account and the delay aversion theory, a group by stimulation effect was hypothesised. For two categories of activity this was found, with ADHD children displaying more activity than non-ADHD children in the no-stimulation but not in the stimulation condition. These data provide support for the stimulation-seeking function of certain features of ADHD hyperactivity.

An inexpensive system for measuring the processing of relational information by romantic partners

The present paper describes the computer aspects of a reaction time experiment with couples. The hardware consists of two computers connected through a local area network. Issues that deal with the first PC include timing routines, screen control, mice data decoding, and synchronization of computer software--written in Assembler for a PC without hard disk--with information presented in a videotape. The second computer was used for data processing that was written in VBA. Although the system was created for a dedicated purpose, it is easily applicable to other environments.

Differentiating attention-deficit/hyperactivity disorder from pervasive developmental disorder not otherwise specified

This study investigated early clinical differences between children with a diagnosis of pervasive developmental disorder not otherwise specified (PDD-NOS) and children with attention-deficit/hyperactivity disorder (ADHD). Differential diagnoses between the two disorders is often difficult in infancy or early childhood. Twenty-seven children with PDD-NOS were matched with 27 children with ADHD as to IQ and chronological age. Their parents were retrospectively questioned on pre-, peri-, and postnatal complications and on atypical or delayed development of the children between 0 and 4 years of age. This exploratory study revealed almost no differences between both groups with respect to pregnancy or birth complications. The results suggest that differences between the two groups become more pronounced and specific with growing age. Consequently, this investigation offers sufficient guidelines for more specific research with larger samples.

A follow-up study of children born after intracytoplasmic sperm injection (ICSI) with epididymal and testicular spermatozoa and after replacement of cryopreserved embryos obtained after ICSI

The aim of this prospective follow-up study of children born after intracytoplasmic sperm injection (ICSI) was to compile data on karyotypes, congenital malformations, growth parameters and developmental milestones in order to evaluate the safety of this new technique. The study design included karyotyping of the parents and their agreement to genetic counselling and prenatal diagnosis and it was based on a physical examination of the child at the Centre for Medical Genetics at the ages of 2 months, 1 year and at 2 years, where major and minor malformations and psychomotor evolution are recorded. Here we describe the first 57 children born from 40 ICSI pregnancies with epididymal spermatozoa (group 1), the first 50 children born from 34 ICSI pregnancies with testicular spermatozoa (group 2) and the first 58 children born from 48 pregnancies after replacement of cryopreserved ICSI embryos (group 3). Parental karyotypes were obtained from only 72/246 (29%) parents and were all normal. Prenatal karyotypes were determined for a total of 70 samples (40%): 21 in group 1, 15 in group 2 and 34 in group 3. In this last group 2 abnormal 47,XXY karyotypes (5.8%) and no structural aberrations were found. This increase in de-novo sex-chromosomal aberrations has already been described with regard to the first 877 children born after ICSI carried out at our Centre and is probably linked directly to the characteristics of the infertile men treated rather than to the ICSI procedure itself. Major malformations, defined as those causing functional impairment or requiring surgical correction, were observed in four children: two born after ICSI with epididymal spermatozoa, one after ICSI with testicular spermatozoa and one after ICSI and cryopreservation. No particular malformation was disproportionally frequent. In the follow-up examinations at 2 months (107/161 or 66.5%) and at 1 year (37/161 or 22.9%), no additional anomalies were observed. Lost for follow-up rate at 2 months was 33.5%. These observations on a limited number of children do not suggest a higher incidence of diseases linked to imprinting, nor do they suggest a higher incidence of congenital malformations. These observations are still limited in number and should be further completed by others and by collaborative efforts. In the meanwhile patients should be told about the available data before any treatment: there appears to be some risk of transmitted chromosomal aberrations, of de-novo, mainly sex-chromosomal aberrations and of transmitting fertility problems to the offspring. Patients should also be reassured that until now there seems to be no higher incidence of congenital malformations in children born after ICSI with epididymal or testicular spermatozoa or after replacement of ICSI embryos.

'Appropriate' male and female safer sexual behaviour in heterosexual relationships

This paper is an attempt to explore how traditional gender role socialization runs counter to safer sexual practices. Structured interviews (N = 448 sexual encounters) were conducted with heterosexual young adults in 'natural settings' such as summer music festivals and youth houses/youth clubs. Congruent with a perspective of gender role theory, females were found to care more about safer sex. The data do not suggest that females are forced to rely on less efficient ways of practising safer sex, but they have to try harder to be successful. Males may implement safer sex in an encounter without negotiation, because it is obvious, or they just have to mention it at the moment of sexual intercourse. Females have to start negotiating safer sex long before the actual encounter in order to be as successful as males. There is one important critical situation for females, notably the encounter in which they perceive the male to be dominant.

Impact of a school-based prevention programme on traditional and egalitarian adolescents' safer sex intentions

The study assessed the impact of a school-based sexual risk reduction program on adolescent's knowledge, need for information, problem-solving and communications skills, intention to talk about and to practise safer sex. The primary goal of working with adolescents in schools was successful, in that significant treatment effects occurred on knowledge, perception of skills and frequency of communication. The program was not effective in improving intentions to use condoms. Evidence for the importance of social context aspects for safer sexual decision-making was found, since the impact of the programme differed for subjects differing in gender role attitudes.

Prospective follow-up study of 877 children born after intracytoplasmic sperm injection (ICSI), with ejaculated epididymal and testicular spermatozoa and after replacement of cryopreserved embryos obtained after ICSI

A prospective follow-up study of 877 children born after ICSI was carried out. The aim of this study was to compile data on karyotypes, congenital malformations, growth parameters and developmental milestones so as to evaluate the safety of this new technique. The follow-up study included agreement to genetic counselling and prenatal diagnosis and was based on a physical examination at the Centre for Medical Genetics (Dutch-speaking Brussels Free University, Brussels, Belgium) at 2 months, 1 year and 2 years, when major and minor malformations and a psychomotor evolution were recorded. Between April 1991 and July 1995, 904 pregnancies obtained after intracytoplasmic sperm injection (ICSI) led to the birth of 877 children (465 singletons, 379 twins and 33 triplets). Prenatal diagnosis determined a total of 486 karyotypes, of which six were abnormal (1.2%) and six (1.2%) were familial structural aberrations, all transmitted from the father. This slight increase in de-novo chromosomal aberrations and the higher frequency of transmitted chromosomal aberrations are probably linked directly to the characteristics of the infertile men treated rather than to the ICSI procedure itself. In all, 23 (2.6%) major malformations were observed in the children born, defined as those causing functional impairment or requiring surgical correction. No particular malformation was disproportionately frequent. Compared with most registers of children born after assisted reproduction and with registers of malformation in the general population, the figure of 2.6% was within the expected range. These observations should be further completed by others and by collaborative efforts. In the meantime, patiens should be counselled about the available data before any treatment: the risk of transmitted chromosomal aberrations, the risk of de-novo, mainly sex chromosomal, aberrations and the risk of transmitting fertility problems to the offspring. Patients should also be reassured that there seems to be no higher incidence of congenital malformations in children born after ICSI.

Prospective follow-up study of 423 children born after intracytoplasmic sperm injection

In order to evaluate the safety of the intracytoplasmic sperm injection (ICSI) procedure, a prospective follow-up study of 423 children born after ICSI was carried out. The aim of this study was to compile data on karyotypes, congenital malformations, growth parameters and developmental milestones. Before starting the infertility treatment, couples were asked to participate in a follow-up study including genetic counselling and prenatal diagnosis. The follow-up study of the child was based on a visit to the paediatrician-geneticist at birth or at 2 months of age, at 1 year and at 2 years of age when a physical examination for major and minor malformations and a psychomotoric evaluation were done. Between April 1991 and September 1994, 320 pregnancies obtained after ICSI led to the birth of 423 children (222 singletons, 186 twins and 15 triplets). Prenatal diagnosis determined a total of 293 karyotypes, one of which was abnormal (0.3%), and four were benign familial structural aberrations, all inherited from the paternal side. A total of 14 (3.3%) major malformations were observed, defined as those causing functional impairment or requiring surgical correlation. Neurological or developmental problems at the age of 2 months were found in 14 children, four of whom were multiples. Compared to most registers of children born after assisted reproduction and to registers of malformations in the general population, the figure of 3.3% major malformations is within the expected range. Before drawing any firm conclusion, further careful evaluations of the available data are necessary.

Comparative follow-up study of 130 children born after intracytoplasmic sperm injection and 130 children born after in-vitro fertilization

The safety of intracytoplasmic sperm injection (ICSI) as a novel procedure of assisted fertilization may be assessed by the health of the children born. In a prospective follow-up study of children born after assisted procreation, 130 children born consecutively after ICSI were compared with 130 control children born after in-vitro fertilization (IVF). In both groups, mothers were matched for age and had the same standard treatment protocol. There were 74 singleton, 50 twin and six triplet children in each group. Prenatal karyotyping and ultrasound screening, physical examination at birth and developmental milestones, with a follow-up at 2 months and 1 year, were recorded. Prenatal karyotypes were obtained in 100 of the 130 children in the ICSI group compared with 22 of the 130 children in the matched IVF group. All karyotypes were normal except for one prenatally detected mosaicism, which was not confirmed at birth. Four major malformations were detected in the ICSI group (holoprosecencephaly, femur fibula ulna syndrome and palatoschisis in two children), compared with six in the matched IVF group (coarctation of the aorta, palatoschisis, hypospadias, unilateral cryptorchidism, soft tissue syndactily and 11-beta-hydroxylase deficiency). In the ICSI and IVF groups, mean +/- SD birth weights were 2.94 +/- 0.67 and 2.80 +/- 0.73 kg, lengths were 48.46 +/- 3.56) and 47.47 +/- 5.78 cm, and head circumferences were 33.79 +/- 2.20 and 31.19 +/- 8.88 cm respectively. Among the ICSI singletons, the mean +/- SD birth weight was 3.28 +/- 0.58 kg and among the twins it was 2.60 +/- 0.43 kg; for the IVF singletons and matched twins the mean +/- SD birth weights were 3.19 +/- 0.56 and 2.36 +/- 0.61 kg respectively. In conclusion, there was no difference in the paediatric follow-up of 130 children born after ICSI and 130 children born after conventional IVF in age-matched control patients.

Prospective follow-up study of 55 children born after subzonal insemination and intracytoplasmic sperm injection

In 163 couples referred for assisted fertilization, pregnancy was established by subzonal insemination (SUZI), intracytoplasmic sperm injection (ICSI) or a combination of both techniques. These couples agreed to participate in a prospective study that included a prenatal diagnosis and clinical follow-up of the children. No cytogenetic aberrations were observed in 43 children tested. In 23 pregnancies occurring after SUZI, 15 women gave birth to 21 children. After replacement of combined SUZI and ICSI embryos, 10 pregnancies resulted in 8 deliveries with 10 children. Transfer of ICSI embryos led to 130 pregnancies ending in 20 deliveries with 24 children, with many others still ongoing successfully. In total, 55 children have been examined: 29 boys and 26 girls. One child from a singleton pregnancy presented multiple congenital malformations; one twin child presented a quadriparesis. In this observational study on a limited number of children, the incidence of major malformations was not different from the incidence in the general population.