A 10-year follow-up of reproductive outcomes in women attempting motherhood after elective oocyte cryopreservation

STUDY QUESTION

Which reproductive treatment outcomes are observed in women who underwent elective oocyte cryopreservation (EOC) and who returned to the clinic with a desire for a child?

SUMMARY ANSWER

Whether to warm oocytes or to first use fresh own oocytes for ART depends on age upon returning, but both strategies result in favorable reproductive outcomes.

WHAT IS KNOWN ALREADY

Most affluent countries have observed a trend toward postponement of childbearing, and EOC is increasingly used based on the assumption that oocytes cryopreserved at a younger age may extend a woman's reproductive lifespan and mitigate her age-related fertility decline. Although most follow-up studies after EOC have focused on women who requested oocyte warming, a substantial proportion of women who do not conceive naturally will embark on fertility treatment without using their cryopreserved oocytes. Reports on reproductive outcomes in past EOC users are scarce, and the lack of reproductive treatment algorithms in this group of women hampers counseling toward the most efficient clinical strategy.

STUDY DESIGN, SIZE, DURATION

This retrospective observational single-center study encompasses 843 women who had elective oocyte vitrification between 2009 and 2019 at our fertility clinic. Women who underwent fertility preservation for medical or oncological reasons were excluded. This study describes the outcomes of the diverse reproductive treatment strategies performed until May 2022 in women returning to our clinic to attempt motherhood.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Using descriptive statistics, patient characteristics and data of ovarian stimulation (OS) of EOC cycles were analyzed, as well as data related to OS and laboratory data of ART in women who pursued fertility treatment with and/or without using their cryopreserved oocytes. The primary outcome was live birth rate (LBR) per patient after oocyte warming and after ART using fresh oocytes. Secondary outcomes were return rate, utilization rate of the cryopreserved oocytes, laboratory outcomes upon return, and LBR per embryo transfer. A multivariable regression model was developed to identify factors associated with the decision to thaw oocytes as the primary strategy and factors associated with ongoing pregnancy upon return to the clinic.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 1353 EOC cycles (mean ± SD, 1.6 ± 0.9 per patient) were performed. At the time of EOC, the mean age was 36.5 ± 2.8 years, mean anti-Müllerian hormone (AMH) was 2.3 ± 2.0 ng/ml, and 174 (20.6%) women had a partner. On average, 13.9 ± 9.2 mature oocytes were cryopreserved. Two hundred thirty-one (27.4%) women returned to the clinic, an average of 39.9 ± 23.4 months after EOC. Upon returning, their mean age was 40.4 ± 3.1 years, mean AMH was 1.5 ± 1.5 ng/ml, and 158/231 (68.3%) patients had a partner. As a primary approach, 110/231 (47.6%) past EOC users embarked on oocyte warming, 50/231 (21.6%) had intrauterine insemination, and 71/231 (30.7%) had ART using fresh own oocytes. Cumulative LBR (CLBR) was 45.9% (106/231) notwithstanding a miscarriage rate (MR) of 30.7% (51/166) in the entire cohort. In total, 141 women performed oocyte warming at some stage in their treatment trajectory. A subset of 90/231 (39.0%) patients exclusively had oocyte warming (41.6 ± 3.0 years, with 10.0 ± 5.2 oocytes warmed per patient). 52/231 (22.5%) patients exclusively had ART using fresh own oocytes (mean age of 39.0 ± 2.8 years, with 9.9 ± 7.4 mature oocytes retrieved per patient). CLBR was 37/90 (41.1%) in the oocyte warming-only group and 25/52 (48.1%) in the OS-only group. MR/transfer was 25.0% and 29.3% in the oocyte warming-only group and the OS-only group, respectively.

LIMITATIONS, REASONS FOR CAUTION

Both sample size and the retrospective design are limitations of this study. The decision to embark on a specific reproductive treatment strategy was based on patient preference, after counseling on their treatment options. This precludes direct comparison of the efficiency of reproductive treatment options in past EOC users in this study.

WIDER IMPLICATIONS OF THE FINDINGS

Reporting on clinical outcomes of women who underwent EOC and returned to the clinic to embark on divergent reproductive treatment strategies is mandatory to establish guidelines for best clinical practice in this growing patient population.

STUDY FUNDING/COMPETING INTEREST(S)

None.

TRIAL REGISTRATION NUMBER

N/A.

First live birth after fertility preservation using vitrification of oocytes in a woman with mosaic Turner syndrome

PURPOSE

To report the case of a young woman diagnosed with Turner syndrome (TS) who achieved a live birth using her own oocytes that had been vitrified for fertility preservation.

METHODS

A 25-year-old woman with mosaic (45,X/46,XX) TS was referred for fertility preservation (FP) counseling. Serum anti-Müllerian hormone (AMH) level was normal (6.4 µg/L). In view of the unpredictable rate of follicle loss in TS individuals, she requested FP and underwent two cycles of ovarian stimulation (OS) for oocyte cryopreservation (OoC) using a GnRH antagonist protocol and recombinant follicle stimulating hormone (rFSH), 200-250 IU daily for 8 resp. 12 days.

RESULTS

In total, 29 metaphase II oocytes (MII) were vitrified after OS. After conceiving spontaneously and achieving a live birth, she returned to the clinic five years after OoC with a desire for pregnancy using in vitro fertilization (IVF) of her cryopreserved oocytes and preimplantation genetic testing (PGT-A). All 29 MII oocytes were thawed; 23 oocytes survived (79.3%) and were inseminated with partner sperm using intracytoplasmic sperm injection (ICSI). Thirteen oocytes were fertilized resulting in three good quality blastocysts which were vitrified after trophectoderm biopsy for PGT-A using array-CGH. Two blastocysts were found to be euploid. One was thawed and transferred to the uterus using a HRT priming protocol. An uneventful pregnancy occurred. The patient delivered a healthy baby girl weighing 3490 g at 40 weeks of gestation.

CONCLUSIONS

We report the first live birth achieved using cryopreserved oocytes in a woman diagnosed with mosaic TS. Cryopreservation of oocytes after ovarian stimulation is a realistic option for FP in selected post menarche individuals with mosaic TS. Whether PGT-A may reduce the risk of pregnancy loss in TS has to be confirmed by further studies.

P-352 Beyond individualisation: towards a more contextualised understanding of women’s social egg freezing experiences

Study question

What are the moral perceptions and views of women considering social egg freezing?

Summary answer

Participants did not perceive egg freezing as a morally problematic solution to societal problems but addressed concerns about relationship formation and wanted more social efforts.

What is known already

Central to the social egg freezing debate is the individualisation argument which underlines the idea that it is morally problematic to use individual medical-technological solutions, such as egg freezing, to solve the societal challenges women face, for instance in the current labour market. It has been said that, instead of quick medical-technical solutions that target individual women’s bodies, we should focus on substantive changes that target the androcentric work culture. This theme relates to feminist concerns about unnecessary medicalisation geared towards women. Furthermore, there is a call for more empirical studies to back up this central normative claim.

Study design, size, duration

Seventeen participants were recruited by psychologists working in two Belgian centres for reproductive medicine which offer egg freezing for social reasons. In addition, four participants were recruited through via social networks. Interviews took place between February 2019 and November 2020 at a location of the participants’ preference or through online video connections.

Participants/materials, setting, methods

At the beginning of the interview, open questions were asked to invite the participants to speak about social egg freezing in their own words. In the second part of the interview, we used four cards with controversial statements based on a study of the bioethics literature, to encourage the participants to reflect about ethical concerns. In this part, we engaged in Socratic dialogue. For the analysis, thematic analysis was used combined with interdisciplinary collaborative auditing.

Main results and the role of chance

This is the first study providing empirical evidence about (potential) egg freezers’ moral reasoning about individualisation arguments. Most participants in our study could make sense of the individualisation argument but emphasised another societal challenge rather than the current labour market. They highlighted ‘the lack of a partner relationship’ as driving their motivation for this procedure. The shortage of eligible partners has been well defined in social science scholarship about social egg freezing but this element has rarely been articulated in the premises of individualisation arguments. This topic of relationships is challenging to analyse from a normative perspective because it was experienced as much more personal and intimate by the women in our study than for instance measures to realise more fair labour conditions, such as improved access to childcare. Some participants believed egg freezing resulted from individual problems and found the individualisation argument not applicable to their own situation. Furthermore, no participant found the individualisation argument legitimate to depict social freezing as morally problematic. Nonetheless, the participants showed a sense of sympathy with women who lack access to egg freezing and were in favour of societal solutions in several public domains.

Limitations, reasons for caution

Given that we report on a small-scale qualitative study of possible social egg freezers at two Belgian fertility clinics, and that our study foregrounds the voices of mostly white higher educated women who were able to afford this technology, our results cannot be generalised to all social egg freezers.

Wider implications of the findings

Our findings can contribute to a better understanding of previously identified normative arguments (e.g., individualisation and unnecessary medicalisation). There is a definite need to further analyse the complex interplay between respecting autonomous choices and evaluating contextual factors in this debate and other practices where similar individualisation arguments are used.

Trial registration number

Not applicable

P–462 First live birth after fertility preservation using vitrified oocytes in a woman with mosaic Turner syndrome

Study question

Is oocyte vitrification an option for preserving the fertility of women diagnosed with Turner syndrome (TS)?

Summary answer

We report the first live birth achieved using cryopreserved oocytes in a woman diagnosed with mosaic Turner syndrome.

What is known already

Women with TS are at extremely high risk for premature ovarian insufficiency (POI) and infertility. Although the desire of becoming parents may be fulfilled through egg donation or adoption, fertility preservation using ovarian tissue cryopreservation or oocyte vitrification has been offered to adolescents with TS before complete exhaustion of their follicular stockpile. However, women with TS exhibit higher rates of pregnancy loss and obstetric complications, and the feasibility of fertility preservation in TS is hampered by the reduced follicular pool and by concerns about the X chromosomal content of oocytes and follicular cells.

Study design, size, duration

Case report in a university hospital.

Participants/materials, setting, methods

A 25-year-old woman with Turner syndrome mosaicism (45,X0[14]/46,XX[86]) was referred for fertility preservation (FP) counseling. Serum antimüllerian hormone (AMH) level was normal (6.4 µg/L). In view of parenthood postponement and because of the unpredictable rate of follicle loss, the woman underwent two cycles of ovarian stimulation using recombinant follicle stimulating hormone (rFSH), 200–250 IU/day for 8 resp. 12 days, in a GnRH antagonist protocol.

Main results and the role of chance

In total, 29 metaphase II oocytes (MII) were vitrified. Five years later, the patient returned to the clinic with a desire for pregnancy. Because of evidence of considerable AMH decline (–56% in an interval of four years), the patient was advised to utilize her cryopreserved oocytes for in-vitro fertilization with preimplantation genetic testing for aneuploidy screening (PGT-A). All 29 MII oocytes were thawed; 26 oocytes survived (89.7%) and were inseminated using intracytoplasmic sperm injection (ICSI). Thirteen oocytes were fertilized normally. Three good quality blastocysts ensued and were vitrified after trophectoderm biopsy for PGT-A using array-CGH. Two blastocysts were found euploid. One was thawed and transferred into the uterus using a HRT priming protocol. An uneventful pregnancy occurred. The patient delivered a healthy baby girl weighing 3490 g at 40 weeks of gestation.

Limitations, reasons for caution

Cryopreservation of oocytes and/or ovarian tissue in selected postmenarchal girls or young women with Turner syndrome is an investigational FP approach that may result in genetic parenthood. The feasibility of FP in TS individuals is limited to those with evidence of ovarian function, before POI occurs.

Wider implications of the findings: Cryopreservation of mature oocytes after ovarian stimulation is a realistic option for FP in selected postmenarchal individuals with mosaic TS. Whether PGT-A may reduce the risk of pregnancy loss in TS has to be confirmed by further studies.

Trial registration number

Not applicable

P–352 Beyond individualisation: towards a more contextualised understanding of women’s social egg freezing experiences

Study question

What are the moral perceptions and views of women considering social egg freezing?

Summary answer

Participants did not perceive egg freezing as a morally problematic solution to societal problems but addressed concerns about relationship formation and wanted more social efforts.

What is known already

Central to the social egg freezing debate is the individualisation argument which underlines the idea that it is morally problematic to use individual medical-technological solutions, such as egg freezing, to solve the societal challenges women face, for instance in the current labour market. It has been said that, instead of quick medical-technical solutions that target individual women’s bodies, we should focus on substantive changes that target the androcentric work culture. This theme relates to feminist concerns about unnecessary medicalisation geared towards women. Furthermore, there is a call for more empirical studies to back up this central normative claim.

Study design, size, duration

Seventeen participants were recruited by psychologists working in two Belgian centres for reproductive medicine which offer egg freezing for social reasons. In addition, four participants were recruited through via social networks. Interviews took place between February 2019 and November 2020 at a location of the participants’ preference or through online video connections.

Participants/materials, setting, methods

At the beginning of the interview, open questions were asked to invite the participants to speak about social egg freezing in their own words. In the second part of the interview, we used four cards with controversial statements based on a study of the bioethics literature, to encourage the participants to reflect about ethical concerns. In this part, we engaged in Socratic dialogue. For the analysis, thematic analysis was used combined with interdisciplinary collaborative auditing.

Main results and the role of chance

This is the first study providing empirical evidence about (potential) egg freezers’ moral reasoning about individualisation arguments. Most participants in our study could make sense of the individualisation argument but emphasised another societal challenge rather than the current labour market. They highlighted ‘the lack of a partner relationship’ as driving their motivation for this procedure. The shortage of eligible partners has been well defined in social science scholarship about social egg freezing but this element has rarely been articulated in the premises of individualisation arguments. This topic of relationships is challenging to analyse from a normative perspective because it was experienced as much more personal and intimate by the women in our study than for instance measures to realise more fair labour conditions, such as improved access to childcare. Some participants believed egg freezing resulted from individual problems and found the individualisation argument not applicable to their own situation. Furthermore, no participant found the individualisation argument legitimate to depict social freezing as morally problematic. Nonetheless, the participants showed a sense of sympathy with women who lack access to egg freezing and were in favour of societal solutions in several public domains.

Limitations, reasons for caution

Given that we report on a small-scale qualitative study of possible social egg freezers at two Belgian fertility clinics, and that our study foregrounds the voices of mostly white higher educated women who were able to afford this technology, our results cannot be generalised to all social egg freezers.

Wider implications of the findings: Our findings can contribute to a better understanding of previously identified normative arguments (e.g., individualisation and unnecessary medicalisation). There is a definite need to further analyse the complex interplay between respecting autonomous choices and evaluating contextual factors in this debate and other practices where similar individualisation arguments are used.

Trial registration number

Not applicable

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.

A survey on the intentions and attitudes towards oocyte cryopreservation for non-medical reasons among women of reproductive age

BACKGROUND

Although cryopreservation of semen is a routine procedure for preserving male gametes, an efficient method of preserving fertility through oocyte freezing has only recently become available for women. In view of the limited female reproductive lifespan, oocyte freezing can now offer women some protection against the decline in fertility with aging.

METHODS

A survey was performed in Belgium among 1914 women of reproductive age (21-40 years) to assess public attitudes towards the phenomenon called 'social oocyte freezing'. Women were questioned on their awareness of the age-related fertility decline and their views and intentions towards considering undergoing oocyte cryopreservation.

RESULTS

The electronic questionnaire was completed by 1049 women, giving a response rate of 55%, and 25 were excluded as they were incomplete/inconsistent. Our results demonstrate that 31.5% of respondents consider themselves as potential social oocyte freezers, of which 3.1% would definitely consider the procedure. Just over half of the women (51.8%) would not consider the procedure while 16.7% indicated they had no opinion. Potential oocyte freezers are characterized by a higher number of desired children and more openness to oocyte donation. The decision to actually embark on such treatment would primarily depend on conditions, such as the procedure not affecting their natural fertility and the health of future children.

CONCLUSIONS

We conclude that a significant proportion of young women would consider safeguarding their reproductive potential or are at least open to the idea of social oocyte freezing.

International collaborative study of intracytoplasmic sperm injection-conceived, in vitro fertilization-conceived, and naturally conceived 5-year-old child outcomes: cognitive and motor assessments

OBJECTIVE

To date, very few studies have been conducted on the neurodevelopmental well-being of children conceived through intracytoplasmic sperm injection (ICSI). The limitations of these studies often include a lack of comparison with a demographically matched, naturally conceived (NC) group and the investigation of only very young children, with relatively small samples sizes. One study showed that there were no differences in IQ scores among ICSI-conceived, in vitro fertilization (IVF)-conceived, and NC children at 5 years of age. Unfortunately, psychomotor development was not assessed in that study. Because findings regarding these children's cognitive and motor development are inconclusive, the aim of this study was to shed more light on the cognitive and motor development of 5-year-old ICSI-conceived children.

METHODS

A total of 511 ICSI-conceived children were compared with 424 IVF-conceived children and 488 NC controls. Children were recruited in 5 European countries, ie, Belgium, Denmark, Greece, Sweden, and the United Kingdom. Participation rates ranged from 45% to 96% in the ICSI and IVF groups and from 34% to 78% in the NC group. Cognitive and motor development was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) and McCarthy Scales of Children's Abilities (MSCA) Motor Scale, respectively. The WPPSI-R consists of 2 major scales, ie, Verbal and Performance, each including 6 subtests. The 6 Performance Scale subtests are object assembly, geometric design, block design, mazes, picture completion, and animal pegs. The 6 Verbal Scale subtests are information, comprehension, arithmetic, vocabulary, similarities, and sentences. Scores on the Performance and Verbal Scale subtests are summed to yield the performance IQ (PIQ) and verbal IQ (VIQ), respectively. Scores on both the Performance Scale and the Verbal Scale yield the full-scale IQ (FSIQ). IQ scales have a mean score of 100 and a SD of 15. Each subtest has a mean score of 10 and a SD of 3. The MSCA consists of 6 scales, ie, Verbal, Perceptual-Performance, Quantitative, General Cognitive, Memory, and Motor Scale. In this study, only the Motor Scale was administered. This scale assesses the child's coordination during performance of a variety of gross- and fine-motor tasks. Leg coordination, arm coordination, and imitative action tests provide measures of gross-motor ability. Draw-a-design and draw-a-child assess fine-motor coordination, as revealed by the levels of hand coordination and finger dexterity. The mean score for this test is 50, with a SD of .

RESULTS

No differences were identified among ICSI, IVF, and NC children with respect to VIQ, PIQ, or FSIQ scores of the WPPSI-R. Furthermore, there were no differences between groups regarding the discrepancy between VIQ and PIQ scores. These results were not influenced by gender, country, or maternal educational level. However, in the subgroup of firstborn children with mothers who gave birth at an older age (33-45 years), NC children obtained significantly better VIQ and FSIQ scores than did children conceived through assisted reproductive technologies. These differences in VIQ and FSIQ scores between ICSI/IVF and NC children were relative, because NC children scored <1 IQ point higher than ICSI/IVF children. Therefore, these scores show no clinical relevance. For Verbal Scale subtests, variables such as age of the mother at the time of the birth, educational level of the mother, and gender and nationality of the child interacted with mode of conception, resulting in clinically irrelevant differences between scores for the ICSI/IVF and NC groups on the arithmetic, vocabulary, and comprehension subtests. For Performance Scale subtests, these same demographic factors interacted with mode of conception for the block design, object assembly, and animal pegs subtests, again resulting in clinically irrelevant differences among groups. In the 3 groups (ICSI, IVF, and NC), we observed equal numbers of children scoring below 1 SD from the mean on the WPPSI-R and the MSCA.

CONCLUSIONS

This study includes a substantial number of children from several European countries. Apart from a few interaction effects between mode of conception and demographic variables, no differences were found when ICSI, IVF, and NC scores on the WPPSI-R and MSCA Motor Scale were compared. Nevertheless, the aforementioned interaction effects could indicate that demographic variables such as maternal age at the time of the birth and maternal educational level play different roles in the cognitive development of IVF and ICSI children, compared with NC children. Additional research is needed to explore and verify this finding. Previous studies revealed that ICSI children, in comparison with NC children, more frequently obtained scores below 1 SD from the mean on 3 subtests of the Performance Scale (object assembly, block design, and mazes) or showed a trend of 5.2% of ICSI children, compared with 2.5% of IVF children and 0.9% of NC children, obtaining a score below 1 SD from the mean, but those findings were not confirmed in this study. Here no differences were found among the 3 groups in the numbers of children scoring below 1 SD from the mean on the VIQ, PIQ, and FSIQ tests and the Verbal and Performance Scale subtests. Motor development results were somewhat more conclusive. There were no differences between the scores of ICSI, IVF, and NC children on the MCSA Motor Scale. No interaction effects were found between mode of conception and demographic variables, indicating that these results are not influenced by gender, nationality, maternal educational level, or maternal age at the time of the birth. Furthermore, equal proportions of children in all 3 groups scored below 1 SD from the mean. The results of this study are reassuring for parents who conceived through ICSI (or IVF). The findings indicate that the motor and cognitive development of their offspring is very similar to that of NC children. However, demographic factors such as maternal educational level and maternal age at the time of the birth might play different roles in the cognitive development of ICSI and IVF children, compared with NC children.

Psychological follow-up study of 5-year-old ICSI children

BACKGROUND

The developmental outcomes of children born after ICSI are still a matter of concern. The purpose of the present study was to investigate psychological outcomes for 5-year-old children born after ICSI and compare these with outcomes for children born after spontaneous conception (SC).

METHODS

Three hundred singleton children born after ICSI in Belgium, Sweden and the USA were matched by maternal age, child age and gender. Outcome measures included the Wechsler Preschool and Primary scales of intelligence (WPPSI-R), Peabody Developmental Motor Scales, Parenting Stress Index and Child Behaviour Checklist.

RESULTS

Regarding cognitive development, no significant differences were found on WPPSI-R verbal and performance scales between ICSI and SC children. However, some differences were noted on subtests of the Performance Scale. ICSI children more often obtained a score below 1 SD of the mean on the subtests: Object Assembly, Block Design and Mazes (all P<0.05). Significant differences by site (i.e. Belgium, Sweden and New York) were found on subtests related to parenting stress, child behaviour problems and motor development (all P<0.05). These findings can probably be explained by variables other than conception mode, such as cultural differences and selection bias.

CONCLUSIONS

Although the finding that a higher proportion of ICSI children obtained scores below the cut-off on some of the visual-spatial subscales of the WPPSI-R warrants further investigation, ICSI does not appear to affect the psychological well-being or cognitive development at age 5.

The influence of assisted reproduction on family functioning and children's socio-emotional development: results from a European study

BACKGROUND

ICSI is used with increasing frequency, but there is less information about the children born following this method of assisted reproduction than other forms of IVF. Some authors have suggested that it may contribute to more family stress than IVF.

METHODS

ICSI conceived children were compared with IVF conceived children and naturally conceived (NC) controls. They were selected in five European countries: Belgium, Denmark, Greece, Sweden and the UK, and seen for psychological testing and a paediatric examination when they were 5 years old. In all countries, except Greece, mothers and fathers were asked to complete questionnaires about parental well-being, family relationships, parenting and child behaviour.

RESULTS

Very few differences were found between the ICSI and NC group or the ICSI and IVF group. The only significant differences were that mothers in the ICSI conceived group reported fewer hostile or aggressive feelings towards the child and higher levels of commitment to parenting than the mothers of NC children.

CONCLUSIONS

The study confirms the results of previous work with IVF families. This should be encouraging for families using these techniques in the future.