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Human Reproduction Update Advance Access published online on August 21, 2009
Human Reproduction Update, doi:10.1093/humupd/dmp030
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Karyotyping, congenital anomalies and follow-up of children after intracytoplasmic sperm injection with non-ejaculated sperm: a systematic review

G.H. Woldringh1,4, D.E. Besselink1, A.H.J. Tillema2, J.C.M. Hendriks3 and J.A.M. Kremer1

1 Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, The Netherlands 2 Medical Library, Radboud University Nijmegen Medical Centre, The Netherlands 3 Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, The Netherlands

To whom correspondence should be addressed at: 4 Correspondence address. E-mail: g.woldringh{at}obgyn.umcn.nl

BACKGROUND: For men with azoospermia, it is possible to father their own progeny by intracytoplasmic sperm injection (ICSI) with epididymal or testicular sperm. Some studies show that children born after assisted reproductive technology (ART) are at increased risk of birth defects, other studies suggest that there is no extra concern about ICSI children conceived with epididymal or testicular sperm.

METHODS: Studies about the karyotypes of fetuses, congenital anomalies and the follow-up of the children born after ICSI with non-ejaculated sperm were identified by means of a systematic literature search.

RESULTS: Eight relevant studies were identified; two studies reported karyotype, five reported malformations and one reported follow-up of children after ICSI. In total, there were 55 out of 1973 (2.8%) abnormal karyotypes in the ICSI with ejaculated sperm group, 0 out of 31 in the ICSI with epididymal sperm group and 5 out of 191 (2.6%) in the ICSI with testicular sperm group. Major malformations were found in 543 out of 12 377 (4.4%) in the ICSI with ejaculated sperm group, 17 out of 533 (3.2%) in the ICSI with epididymal sperm group and 31 out of 670 (4.6%) in the ICSI with testicular sperm group.

CONCLUSIONS: Although there were no statistical differences, the study groups were small and heterogenic, with a number of potential biases. We therefore recommend a standardized methodology of follow-up studies after ART, with well-defined groups of ICSI with ejaculated sperm, ICSI with epididymal sperm and ICSI with testicular sperm, and a control group of naturally conceived children.

Key words: ICSI / non-ejaculated sperm / karyotyping / congenital anomalies / follow-up

Received on February 5, 2009; revised July 16, 2009; accepted on July 28, 2009


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