title: Follow-up of children born after ICSI with epididymal spermatozoa.
abstract: BACKGROUND
  To evaluate the safety of ICSI with epididymal sperm, this study compared children born after ICSI treatment with epididymal sperm and children conceived after IVF and ICSI with ejaculated sperm. Additionally, the results of a multidisciplinary, multicentre follow-up of the children conceived with epididymal sperm at 2 years of age are described.
  
  
  METHODS
  This follow-up study included 378 children conceived after ICSI with epididymal sperm (percutaneous epididymal sperm aspiration: PESA group) and a control group of 1192 IVF and 1126 ICSI (with ejaculated sperm) children, all with a gestational age of 20 weeks or more. Questionnaires were sent at birth, 1 year and 4 years of age, collecting data on parental, pregnancy and child factors. A total of 148 PESA children were assessed at 2 years of age for motor performance, mental- and language development and compared with the Dutch norms.
  
  
  RESULTS
  PESA children showed no increased risks for stillbirths, total deaths and malformations. They also did not differ from IVF and ICSI children in gender rate, birthweight and gestational age. The mental Bayley score was higher (P < 0.05) for PESA singletons and parents reported fewer (P < 0.05) behavioural problems in the PESA group than the Dutch reference group. The scores for syntactic and lexical development for the PESA singletons were better (P < 0.05) than the Dutch standards.
  
  
  CONCLUSIONS
  ICSI with epididymal sperm does not lead to more stillbirths or congenital malformations in comparison to IVF and ICSI with ejaculated sperm and does not lead to poor development in comparison with the Dutch reference group.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.woldringh@obgyn.umcn.nl
authors.forename: G H
authors.initials: GH
authors.lastname: Woldringh
authors.forename: M
authors.initials: M
authors.lastname: Horvers
authors.forename: A J W M
authors.initials: AJ
authors.lastname: Janssen
authors.forename: J J C M
authors.initials: JJ
authors.lastname: Reuser
authors.forename: S A F
authors.initials: SA
authors.lastname: de Groot
authors.forename: K
authors.initials: K
authors.lastname: Steiner
authors.forename: K W
authors.initials: KW
authors.lastname: D'Hauwers
authors.forename: A M M
authors.initials: AM
authors.lastname: Wetzels
authors.forename: J A M
authors.initials: JA
authors.lastname: Kremer
mesh_terms: D002648:Child; D000013:Congenital Abnormalities / Q000453:epidemiology; D004822:Epididymis / Q000166:cytology; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D018570:Risk Assessment; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects* / Q000379:methods; D053625:Sperm Retrieval; D013094:Spermatozoa; D014427:Twins