Cognitive development of singletons born after intracytoplasmic sperm injection compared with in vitro fertilization and natural conception

Knoester, Marjolein; Helmerhorst, Frans M.; Vandenbroucke, Jan P.; van der Westerlaken, Lucette A.J.; Walther, Frans J.; Veen, Sylvia; Leiden Artificial Reproductive Techniques Follow-up Project,

doi:10.1016/j.fertnstert.2007.06.090

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Volume 90, Issue 2 , Pages 289-296, August 2008

Cognitive development of singletons born after intracytoplasmic sperm injection compared with in vitro fertilization and natural conception

Marjolein Knoester, M.Sc.
- Department of Pediatrics, Neonatal Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Gynecology, Division of Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands
Frans M. Helmerhorst, M.D., Ph.D.
- Department of Gynecology, Division of Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
Jan P. Vandenbroucke, M.D., Ph.D.
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
Lucette A.J. van der Westerlaken, Ph.D.
- Department of Gynecology, Division of Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands
Frans J. Walther, M.D., Ph.D.
- Department of Pediatrics, Neonatal Center, Leiden University Medical Center, Leiden, The Netherlands
Sylvia Veen, M.D., Ph.D.
- Department of Pediatrics, Neonatal Center, Leiden University Medical Center, Leiden, The Netherlands
- Reprint requests: Sylvia Veen, M.D., Ph.D., Department of Pediatrics, Neonatal Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands (FAX: +31 (0) 71-524-8198).
Leiden Artificial Reproductive Techniques Follow-up Project

Received 24 April 2007; received in revised form 27 June 2007; accepted 27 June 2007. published online 02 November 2007.

Objective

To investigate cognitive development of singletons conceived by intracytoplasmic sperm injection (ICSI) at 5–8 years of age.

Design

Follow-up study.

Setting

University medical center, assessments between March 2004 and May 2005.

Patient(s)

Singletons born between June 1996 and December 1999 after ICSI at the Leiden University Medical Center were compared with matched singletons born after IVF and natural conception (NC).

Intervention(s)

Mode of conception.

Main Outcome Measure(s)

Intelligence quotient (IQ) was measured with the Revised Amsterdam Child Intelligence Test (short form). The investigators were blinded to conception mode.

Result(s)

Singletons conceived by ICSI (n = 83) achieved lower IQ scores than IVF singletons (n = 83) (adjusted mean difference IQ: 3.6 [95% confidence interval (CI) −0.8, 8.0]). After categorizing IQ outcomes (<85, 85–115, >115), no significant difference in the distribution of IQ was found. Singletons conceived by ICSI (n = 86) achieved lower IQ scores than NC singletons (n = 85); the adjusted mean difference varied between 5 and 7 points (5.6 [95% CI 0.9, 10.3]; 7.1 [95% CI 1.7, 12.5]) depending on the covariates included in the model. Adjustment for prematurity did not change the results. Percentages in IQ categories <85, 85–115, and >115 were 12%, 64%, and 24% for ICSI and 6%, 54%, and 40% for NC, respectively.

Conclusion(s)

In the relatively limited sample investigated, cognitive development among ICSI singletons was lower than among IVF and NC singletons. Infertility factors or unmeasured confounders may play a role.

Key Words: ICSI, IVF, child development, intelligence