Outcome of pregnancies after intracytoplasmic sperm injection and the effect of sperm origin and quality on this outcome.

Objective: To describe the outcome of pregnancies obtained after intracytoplasmic sperm injection (ICSI) and the impact of the origin and quality of sperm used on this outcome.

Design: Retrospective analysis.

Setting: A tertiary referral center for assisted reproduction.

Patient(s): Pregnant patients conceived after microinjection of ejaculated sperm (n=1,427), epididymal sperm (n=79), and testicular sperm (n=93).

Intervention(s): ICSI, epididymal sperm aspiration, and testicular biopsy.

Main Outcome Measure(s): Stillbirth, prematurity, and early perinatal mortality.

Result(s): The delivery rate of multiple births was 31.4%, and the preterm delivery rate was 25.6%. The prematurity rates in singletons, twins, and triplets were 9.9%, 56.7%, and 96.6%, respectively. The early perinatal mortality rate of the entire population was 26.1 per thousand. In the ejaculated-sperm group, when the sperm was severely defective (group 1), 14 intrauterine deaths occurred (3.1%). In the second and third groups, in which sperm was moderately defective, there were 2 deaths and 1 death (0.6% and 0.4%), respectively. The difference between the number of deaths in group 1 vs. groups 2/3 was statistically significant.

Conclusion(s): The rates of multiple pregnancies, preterm deliveries, low birth weight, and early perinatal mortality were higher after ICSI than after natural conception. In the ejaculated-sperm group, the rate of intrauterine death was higher in the severely defective sperm group than in the better-quality sperm groups.