So Far, So Good
At the 22nd annual conference of the European Society of Human Reproduction and Embryology, participants heard that a study of 150 of the world's oldest children produced by ICSI confirmed that, for the most part, ICSI kids are healthy. Dr. Florence Belva, however, admitted that kids conceived with the help of intra-cytoplasmic sperm injection (ICSI) have a higher than average risk for major congenital malformations and that this finding echoes the results of earlier studies. Dr. Belva believes this risk may be due more to the genetic history of the parents rather than to the ICSI procedure.
The pediatrician and research assistant at the Centre for Medical Genetics Vrije Universiteit Brussels, Belgium explained that ever since the introduction of ICSI in 1991, concerns have been voiced regarding potential health risks and the possibility of impaired fertility looming in the future of offspring produced by the technique. Earlier studies proved reassuring as experts studied the children between the ages of birth to 5 years. This study, however, is the first to look at the health status of ICSI kids at 8 years of age, just prior to the onset of puberty.
Experts performed physical and neurological examinations on 150 children conceived by ICSI, 76 boys and 74 girls and compared the results with those of 147 children, 76 boys and 71 girls born by natural conception. All the participants were singletons, Dutch-speaking, had at least one European-born parent. None were very premature.
Dr. Belva explained that major congenital malformations were classified as those causing an impairment of function and/or requiring correctional surgery. Other malformations were classified as minor.
Among major malformations seen in the ICSI children were dextrocardia, in which the apex of the heart points in the wrong direction, sizeable port wine stains (naevus flammeus), herniated groin, squinting, and problems with the ureter, or the tube that brings the urine from the kidneys to the bladder. Minor malformations included overriding toes, where one overlaps another, mongoloid eyes, and ear abnormalities.
Despite these findings, no medical issues considered major were found in either group. Comparable figures for weight, height, circumference of the head, and Body Mass Index (BMI) were seen in both groups. 10% of the ICSI children, or 15 out of 150, were found to have a major congenital malformation as compared to 3.3%, or 5 out of 147, of the spontaneously conceived (SC) kids. Minor malformations occurred in 24.1%, or 35 out of 145 ICSI children, as compared to 17.2%, or 25 out of 145 children in the SC group.
These results were reassessed by a Western Australia research team according to a different coding system. This reassessment showed a reduction in the number of major congenital malformations down to 4% from 10% among the ICSI group, and down from 3.3% to 0% in the SC children. Minor malformations went down to 4.8% from 24.1% in the ICSI group and from 17.2% down to 4.8% in the SC kids.
"Other results showed little, if any, difference between ICSI and SC children, physically or neurologically…There was no greater medication intake or more chronic disease among the ICSI children," said Dr Belva, who also commented that the children in the ICSI group were not any more likely to have required additional therapy, surgery, or hospitalization.
The differences between the ICSI and SC children are not seen as statistically significant from a clinical standpoint. Belva says that it's important to keep in mind that malformations such as those seen in the study are also found among the normal population by dint of genetic inheritance, the environment, disease, and other causes. Still, researchers remain cautious about possible fertility problems cropping up as puberty beckons.