title: Malformation rate and sex ratio in 412 children conceived with epididymal or testicular sperm.
abstract: BACKGROUND
  Follow-up studies of children conceived after ICSI using epididymal or testicular sperm are important due to a still more extensive use of immature male germ cells for ICSI. It is, however, difficult to evaluate the potential risks of malformations of children born after ICSI, overcoming the natural fertilization processes, due to methodological limitations.
  
  
  METHODS
  Follow-up study including all children born in Denmark and Norway following ICSI in Denmark, using epididymal or testicular sperm, was done. A questionnaire was sent to the parents between 3 months and 7 years after delivery.
  
  
  RESULTS
  Of 341 couples, 329 returned the questionnaire giving a response rate of 96.5%. The study included 412 children, 225 girls and 187 boys, giving a sex ratio (males/males + females) of 45.4% compared with 53.1% in Danish children conceived after conventional IVF without ICSI (P < 0.005). Among a total of 14 (3.4%; 95% confidence interval (CI): 1.9%-5.7%) major malformations, three boys with hypospadias were the most remarkable finding (1.6%; 95% CI: 0.33-4.7%).
  
  
  CONCLUSIONS
  An increased frequency of hypospadias in the male offsprings was seen compared with the general population. Apart from this, no increased major malformation rate was detected in ICSI children conceived with epididymal or testicular sperm when compared with malformation rates for IVF or spontaneously conceived children reported in the literature. The sex ratio was significantly lower for ICSI children conceived with epididymal or testicular sperm when compared with children conceived with conventional IVF.
authors.affiliation: The Fertility Clinic, Braedstrup Hospital, Braedstrup, Denmark. jfe@bs.vejleamt.dk
authors.forename: Jens
authors.initials: J
authors.lastname: Fedder
authors.forename: A
authors.initials: A
authors.lastname: Gabrielsen
authors.forename: P
authors.initials: P
authors.lastname: Humaidan
authors.forename: K
authors.initials: K
authors.lastname: Erb
authors.forename: E
authors.initials: E
authors.lastname: Ernst
authors.forename: A
authors.initials: A
authors.lastname: Loft
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis* / Q000209:etiology*; D000328:Adult; D004822:Epididymis / Q000378:metabolism* / Q000473:pathology*; D005260:Female; D005306:Fertilization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D012737:Sex Factors; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods; D013094:Spermatozoa / Q000473:pathology*; D011795:Surveys and Questionnaires; D013737:Testis / Q000473:pathology*