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. 2008 Jan;105(1-2):11-7.
doi: 10.3238/arztebl.2008.0011. Epub 2008 Jan 7.

The risk of malformation following assisted reproduction

Hilke Bertelsmann  1 , Helena de Carvalho Gomes, Monika Mund, Susanne Bauer, Katja Matthias
Affiliations

The risk of malformation following assisted reproduction

Hilke Bertelsmann et al. Dtsch Arztebl Int. 2008 Jan.

Abstract

Introduction: Intracytoplasmatic sperm injection (ICSI) is currently the most frequently used human reproductive technology in Germany. ICSI was introduced as routine, insurance-funded medical care in 2002 by the Federal Joint Committee. A re-evaluation of published literature on malformation rates in children born of ICSI pregnancies within a period of three years formed part of the committee's decision. The analysis investigated whether ICSI increases the risk of malformation in the offspring, compared to in vitro fertilization (IVF) and natural conception.

Methods: Systematic literature review.

Results: 929 studies were identified. Three meta-analyses, 15 studies investigating malformations, and 12 studies analyzing imprinting disorders were included. The risk of malformation was not significantly different in nine studies comparing ICSI versus IVF. Two meta-analyses and three of eight cohort studies and retrospective analysis showed significantly more severe malformations after assisted reproduction than after natural conception. The remaining five studies displayed no significant results. Current evidence does not show a higher risk of major malformations in the offspring resulting from the use of ICSI compared to IVF. However, there is evidence that both techniques increase the risk for major malformations considerably, compared to natural conception, and further research is needed. The validity of the results is low since the studies were heterogeneous and the cohorts used in the studies had limited comparability.

Keywords: assisted reproduction; congenital malformation; in vitro fertilization; intracytoplasmic sperm injection; literature review.

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Figures

Diagram 1
Diagram 1
Treatment options for infertility covered by statutory health insurance in Germany
Diagram 2
Diagram 2
The number of treatments paid for by statutory health insurance in Germany from 2002 to 2005 including insemination techniques, in vitro fertilization, and intracytoplasmic sperm injection. From 2004 onward, couples were required to pay 50% of the cost of treatment.
Diagram 3
Diagram 3
Methods used for the literature search
Diagram 4
Diagram 4
Comparison between ICSI and IVF as a function of study size
Diagram 5
Diagram 5
Comparison between ICSI and natural conception as a function of study size
See this image and copyright information in PMC

Comment in

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