De Grandi, P.

Germond, M.

Senn, A.

Singh, L.

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Abstracts of the 15th Annual Meeting of the ESHRE, Tours, France 1999of fetal abnormalities detected by routine ultrasound scanning.Trisomy 18 was found in one of these fetuses.Conclusion: The obstetric outcome in children born afterICSI as a whole is comparable to that of conventional IVFpregnancies with multiple births being the major problem. Thegestational age and birthweight in singletons were higher thanusually reported for IVF. A possible increase in malformationshas to be confirmed in further studies with adequate controlgroups. No increase in malformation rate was seen in any ofthe subgroups of different sperm origin. No sex chromosomeabnormalities was found.10.15-10.300-105. Follow-up of 100 children, aged 1 and 2 years,born after intracytoplasmic sperm injectionSingh L., Senn A., De Grandi P. and Germond M.Reproductive Medicine Unit, Dept. Obstet.-Gynaecol.,CHUV, CH-l0ll Lausanne, SwitzerlandIntroduction: Intracytoplasmic sperm injection (ICSI) is con-sidered a major breakthrough in the treatment of male infertility.Its rate of success is so impressive that it has been carried outworldwide soon after its discovery without any experimentalphase. Concern is being expressed about possible long-termdamage hidden in the genetic ritaterial of these children. Untilnow, most reports about their physical and mental health havebeen reassuring. Our aim was to ascertain the medical anddevelopmental outcome of the children aged 1 and 2 yearsborn after ICSI performed in the CHUV.Materials and methods: Among the pregnancies induced byICSI performed between 1994 and 1996, there were 84deliveries of which 107 children were born alive. Four familiesleft the country without leaving any forwarding details. Thisstudy was subsequently carried out on 100 children (39 girlsand 61 boys), resulting from 80 deliveries, among whom therewere 16 twin and two triple births. The average maternal agewas 31.4 ± 3.9 years. The mean gestational age was 38.6 ±2.3 weeks. The average birthweight was 2823 ± 696 g. ICSIwas performed with ejaculated spermatozoa in 73 cases,with epididymal spermatozoa in six cases, and testicularspermatozoa in one case. The transfer was performed withfresh embryos in 67 cases and thawed embryos in 13 cases.We used two different questionnaires: (i) the medical dataconcerning the pregnancy and the delivery were collectedthrough 'questionnaire l' filled out by the obstetrician, (ii) thefollow-up of the childrens' physical and mental developmentwas carried out using 'questionnaire 2', provided by DrBonduelle, VUB. This questionnaire was completed aftera telephone inquiry between the investigator and one ofthe parents.Results: 'Questionnaire l' showed that two children had majormalformations detected at birth: one of them suffered fromtrisomy 21 (the mother had not wanted to terminate thepathological pregnancy that had been detected by the tripletest) and the other child had severe internal malformations(oesotracheal fistula with tracheal atresia, pulmonary atelectasy,58and renal ectopy). 'Questionnaire 2' showed that: (a) ninechildren had minor malformations which had not been detectedat birth: there were three cases of phimosis, two cases ofbilateral inguinal hernias and one case of the following:unilateral inguinal hemia, hypospadias, haemangioma, bilateraltesticular hydroceles and a toe malformation, (b) 99 childrenshowed normal physical and mental development: 54 childrenat the age of 2 years and 45 children at the age of 1 year.Difficulties in the collection of data for both questionnaireswere mainly due to (i) the patients changing their address, (ii)the obstetrician not returning the questionnaire to us. Two percent of these children suffered from major malformations,which were noted at birth, through 'questionnaire 1'. Nine percent suffered from minor malformations which were not notedat birth, but were detected through 'questionnaire 2'.Conclusion: The obstetrical questionnaire, which is generallyused in the national registers, proves to be insufficient fordetecting minor malformations among children born after ICSI.Even though there is evidence that ICSI results in normalpregnancies, regular follow-up of these children from their timeof birth ideally up to their reproductive age is recommended. Asimple annual telephone call could be used and the follow-upconducted in a fully transparent manner with the childrenand their parents. Long-term follow-up requiring an efficientnetwork would be necessary only in the abnormal casesdetected by 'questionnaire 2'.10.30-10.450-106. Chromosomal anomalies and malformations afterICSI without the use of PVPHamori M. and Antoni K.IVF Centre, Erlangen, GermanyIntroduction: The long-term follow-up of pregnancies andchildren born after ICSI is henceforth of absolute necessity.In this respect it seems to be interesting to evaluate the resultsof our programme, because we never used polyvinylpyrrolidone(PVP) for the immobilization of spermatozoa. PVP as anunnatural chemical substance was repeatedly considered tohave a detrimental effect on embryonic development. Thoughthe data of large ICSI surveys conducted in centres usingPVP are reassuring, the need for the long-term comparisonstill remains.Materials and methods: Out of the nearly 1000 pregnanciesachieved after ICSI, the data of 570 newborns were evaluatedby a routine paediatric follow-up. Fresh and frozen-thawedcycles, pregnancies from ejaculated and surgically retrievedspermatozoa were analysed together. Fetal karyotype wasperformed where possible on amniocentesis samples. A totalof 271 chromosomal complements were documented; some ofthe pregnancies after prenatal diagnosis are still ongoing. Inaddition, the karyotypes of male partners with a sperm count< lOX 106 or with severe asthenozoospermia were also exam-ined. The malformation rate of singleton and multiple pregnan-cies was evaluated separately.Results: In total, 22 major malformations were reported,13 in singleton and nine in twin pregnancies. The overall

O-105. Follow-up of 100 children, aged 1 and 2 years, born after intracytoplasmic sperm injection

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