title: Low birth defects by deselecting abnormal spermatozoa before ICSI.
abstract: Consistent evidence from meta-analysis has linked assisted conception by IVF, and particularly intracytoplasmic sperm injection (ICSI), with an increased risk of major birth defects. To compare the risk of major malformations of children born after standard ICSI and after intracytoplasmic injection of morphologically selected spermatozoa (IMSI), a prospective population-based study was conducted from 2005 to 2010. ICSI and IMSI were performed in only one assisted reproduction unit according to its classification of spermatozoa and using fresh semen. Medical data and follow up during 2 years of 1028 infants were collected. Major malformations were identified and classified by an external independent physician. The two groups were similar concerning the parents' age, treatment, number of oocytes recovered, days of transfer, gestational age and birthweight. However, major malformations were significantly lower with IMSI (6/450, 1.33%) versus ICSI (22/578, 3.80%; adjusted odds ratio 0.35, 95% confidence interval 0.14-0.87, P=0.014), mainly affecting boys (adjusted odds ratio 2.84, 95% confidence interval 1.24-6.53, P=0.009). In conclusion, the significantly decreased risk of major birth defects associated with IMSI remained decreased after multivariate adjustment and highlights the beneficial effect of sperm selection before ICSI.
authors.affiliation: Art Unit, Drouot Laboratory, Drouot Street, Paris 75009, France. Electronic address: guycassuto@labodrouot.com.
authors.forename: Nino Guy
authors.initials: NG
authors.lastname: Cassuto
authors.affiliation: Art Unit, Drouot Laboratory, Drouot Street, Paris 75009, France.
authors.forename: André
authors.initials: A
authors.lastname: Hazout
authors.affiliation: Art Unit, Drouot Laboratory, Drouot Street, Paris 75009, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Bouret
authors.affiliation: Bleuets Hospital, Lasson Street, Paris 75012, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Balet
authors.affiliation: Diaconesses Saint Simon Hospital, Sergent Bauchard Street, Paris 75012, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Larue
authors.affiliation: Trousseau Hospital, Arnold Netter Avenue, Paris 70012, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Benifla
authors.affiliation: Cochin Hospital, Faubourg Saint Jacques, Paris 75014, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Viot
mesh_terms: D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008858:Microscopy, Phase-Contrast; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012737:Sex Factors; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013094:Spermatozoa / Q000145:classification / Q000166:cytology*; D018709:Statistics, Nonparametric
keywords: ICSI; IMSI; birth defects; high magnification; sperm head