[Effect of surgical versus ejaculated sperm retrieval for intracytoplasmic sperm injection on intellectual and physical development of offspring aged 3-6 years: A retrospective cohort study].

Abstract

Objectives: To compare the effects of surgically retrieved versus ejaculated sperm retrieval for intracytoplasmic sperm injection (ICSI) on intellectual and physical development in offspring aged 3-6 years.

Methods: A total of 5481 offspring aged 3-6 years who were conceived through assisted reproductive technology and delivered at the Reproductive Center of Affiliated Women's Hospital, Zhejiang University School of Medicine were enrolled, including 305 in the ICSI with surgically retrieved sperm (ICSI-surgical) group, 1131 in the ICSI with ejaculated sperm (ICSI-ejaculated) group, and 4045 in the conventional in vitro fertilization (IVF) with ejaculated sperm (IVF-ejaculated) group. Using the IVF-ejaculated group as the reference, intellectual and physical development outcomes of offsprings were compared between the ICSI-surgical and ICSI-ejaculated groups. Outcome measures included verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), full-scale intelligence quotient (FIQ), intellectual disability (FIQ<70), as well as underweight, stunting, wasting, overweight, and obesity. Generalized estimating equations were used to account for familial clustering and confounding factors, and a sensitivity analysis was performed in singleton offspring (n=3295).

Results: In the ICSI-surgical group, maternal age, maternal height, maternal weight, maternal body mass index, paternal age, paternal height, sperm concentration, and sperm motility were lower than those in the ICSI-ejaculated group (all P<0.017), while the proportion of primary infertility and the incidence of anemia during pregnancy were higher than those in the ICSI-ejaculated group (all P<0.017). The ICSI-surgical group had a higher risk of obesity than the ICSI-ejaculated group (OR= .94, 95%CI: 1.09-3.48, P=0.025), although this difference was of borderline significance after Bonferroni correction (adjusted P=0.050); no significant differences were observed in intellectual or other physical development outcomes (all P>0.05). In the singleton sensitivity analysis, the surgical group showed an increased risk of obesity (OR=2.15, 95%CI: 1.03-4.36, P=0.043); however, this difference was not statistically significant after Bonferroni correction (adjusted P=0.086). No significant differences were found between the ICSI-ejaculated and IVF-ejaculated groups for any outcome (all adjusted P>0.05).

Conclusions: In ICSI cycles, surgically retrieved sperm was not associated with significant differences in intellectual or physical development among offspring aged 3-6 years compared with ejaculated sperm.