严重男性不育症ICSI子代与其他ICSI/IVF子代生长和智力发育的比较研究

Growth and Neurodevelopmental Outcome of Children Born after ICSI with Spermatozoa from Severe Male Infertility

目的：探讨严重男性不育患者借助卵胞质内单精子注射（ICSI）技术出生子代的生长和智力发育情况。方法：对接受ICSI/IVF治疗的237个家庭出生的300例子代进行召回后现场随访,并进行全面体格检查和智力测试,按ICSI/IVF当日精液情况和受精方式分为4组,附睾/睾丸精子ICSI组患者92例,子代118例（A组）;严重少/弱精子ICSI组患者84例,子代106例（B组）;其它精子ICSI组患者35例,子代42例（C组）;正常精子IVF组患者26例,子代34例（D组）（C组和D组为对照组）。结果：受访子代实足年龄4~84个月,平均33.5个月,4组子代绝大部分身高和体质量达同龄儿童标准范围。婴幼儿组有51例进行Gesell智力量表检测,A、B组和C/D对照组分别检测了17、24、10例,无一例存在明显智力障碍;学龄前儿童组96例进行了WPPSI-R智力量表检测,A、B和C/D对照组分别检测了50、30、16例,语言智力评分分别为105±20分、103±21分、115±16分（P=0.119）,操作智力评分分别为124±18分、120±24分、125±17分（P=0.64）,总智力评分分别为116±18分、112±23分、122±15分（P=0.303）。结论：无精子症和严重少/弱精子症等严重男性不育症患者ICSI子代的生长和智力发育情况与较好精子或正常精子ICSI/IVF子代相比无统计学差异。

Objective： To investigate the growth and neurodevelopmental outcome of children born after intracytoplasmic sperm injection （ICSI） using spermatozoa from severe male infertility. Methods： In total, 237 infertile couples who received ICSI with 300 children were recruited from reproductive center. All ICSI children were invited to undertake physical examination and Wechsler preschool and primary scale of intelligence-R （WPPSI-R, children older than 3 years old） or Gesell development schedule （children younger than 3 years old）. According to sperm parameters, couples were divided into four groups. Group A was defined as azoospermia, including 92 couples with 118 children. Group B was defined as severe oligozoospermia/asthenospermiaJteratozoospermia （OAT）, including 84 couples with 106 children. Group C was defined as mild or moderate oligozoospermia/asthenospermia, including 35 couples with 42 children. Group D was defined as normal sperm parameter with female infertility, including 26 couples with 34 children. Groups C and D were regarded as control group. Results： Children＇s age at follow-up ranged from 4 to 84 months old, the mean age was 33.5 months old. Height and weight measurements of all children showed that more than 95% were in the standard range. Fifty-one children performed GESELL test, including 17 children in group A, 24 children in group B and 10 children in group C/D. The results revealed that except two children in group A had a slightly low performance IQ, the rest were all normal. Ninty-six children performed WPPSI-R, including 50 children in group A, 30 children in group B and 16 children in group C/D, the average verbal IQ was 105± 20, 103± 21, 115± 16 （P=0.119）, respectively, the average performance IQ was 124 ± 18, 120 ± 24, 125± 17 （P=0.64）, respectively, the full scale IQ was 116 ± 18, 112 ± 23, 122 ± 15 （P=0.303）, respectively. No significant difference was found among groups. Conclusion： There is no evidence of differences in growth and neurodevelopment of children born after ICSI with spermatozoa from severe male infertility.