Outcome of pregnancies after intracytoplasmic sperm injection and the effect of sperm origin and quality on this outcome.

OBJECTIVE

To describe the outcome of pregnancies obtained after intracytoplasmic sperm injection (ICSI) and the impact of the origin and quality of sperm used on this outcome.

DESIGN

Retrospective analysis.

SETTING

A tertiary referral center for assisted reproduction.

PATIENT(S): Pregnant patients conceived after microinjection of ejaculated sperm (n=1,427), epididymal sperm (n=79), and testicular sperm (n=93).

INTERVENTION(S): ICSI, epididymal sperm aspiration, and testicular biopsy.

MAIN OUTCOME MEASURE(S): Stillbirth, prematurity, and early perinatal mortality.

RESULT(S): The delivery rate of multiple births was 31.4%, and the preterm delivery rate was 25.6%. The prematurity rates in singletons, twins, and triplets were 9.9%, 56.7%, and 96.6%, respectively. The early perinatal mortality rate of the entire population was 26.1 per thousand. In the ejaculated-sperm group, when the sperm was severely defective (group 1), 14 intrauterine deaths occurred (3.1%). In the second and third groups, in which sperm was moderately defective, there were 2 deaths and 1 death (0.6% and 0.4%), respectively. The difference between the number of deaths in group 1 vs. groups 2/3 was statistically significant.

CONCLUSION(S): The rates of multiple pregnancies, preterm deliveries, low birth weight, and early perinatal mortality were higher after ICSI than after natural conception. In the ejaculated-sperm group, the rate of intrauterine death was higher in the severely defective sperm group than in the better-quality sperm groups.