ABSTRACT
OBJECTIVE: To compare reproductive hormone levels and antral follicle count in intracytoplasmic sperm injection (ICSI)-conceived offspring and peers born after spontaneous conception. DESIGN: Single-center study of the reproductive health at the age of 18-22 years in the worldwide oldest cohort of female ICSI offspring. SETTING: University hospital. PATIENT(S): A longitudinally followed cohort of singleton women (n = 71) conceived by means of ICSI because of male infertility and a cross-sectionally recruited group of spontaneously conceived women of the same age (n = 81). INTERVENTIONS(S): None. MAIN OUTCOME MEASURE(S): Differences in serum reproductive hormone levels and ultrasound findings. RESULT(S): Median levels of antimüllerian hormone (AMH), FSH, LH, and DHEAS were similar between ICSI women and their spontaneously conceived counterparts. Median E2 levels in ICSI women taking hormonal contraceptives were higher compared with control women. A minority of ICSI women had AMH levels below the 5th or above the 95th percentile, and ICSI women were not more likely to have AMH levels below the 5th percentile or above the 95th percentile compared with control women. Mean follicle count per ovary was similar between the ICSI and control groups. Furthermore, a similar proportion of women had >19 follicles per ovary (ICSI: 20.9%; control: 20.0%). A strong positive correlation between AMH level and mean follicle count per ovary was found. CONCLUSION(S): In this cohort of 71 young adult women conceived by means of ICSI because of male infertility in their parents, antral follicle count and circulating reproductive hormone levels, including AMH, FSH, LH, and DHEAS, were found to be similar to results from peers born after spontaneous conception.
Subject(s)
Adult Children , Fertility , Gonadal Hormones/blood , Infertility, Male/therapy , Ovarian Follicle/diagnostic imaging , Sperm Injections, Intracytoplasmic , Ultrasonography , Adolescent , Anti-Mullerian Hormone/blood , Biomarkers/blood , Case-Control Studies , Dehydroepiandrosterone Sulfate/blood , Female , Follicle Stimulating Hormone, Human/blood , Hospitals, University , Humans , Infertility, Male/diagnosis , Infertility, Male/physiopathology , Live Birth , Luteinizing Hormone/blood , Male , Predictive Value of Tests , Reproductive Health , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Although the age-effect on in vitro fertilization outcomes has been well documented, data on donor insemination are scarce hampering accurate patient counseling. This cohort study therefore aims at analyzing cumulative delivery rates after donor insemination for various indications. METHODS: A large retrospective analysis was performed on 6630 insemination cycles in 1654 women. Delivery rates were calculated by life-table analysis after a maximum of 12 cycles in five subgroups of age when starting inseminations. Multivariable modeling was used to explore the effects according to age, indication (male infertility, lesbian couple or single-parent request) and ovarian stimulation protocol (none, clomiphene citrate or gonadotrophins). RESULTS: Overall, 928 deliveries were observed, i.e. a delivery rate of 14% per cycle and an expected cumulative delivery of 77% after 12 cycles. Subgroup analysis showed an expected cumulative delivery after 12 cycles of 87% for the group aged 20-29, 77% for ages 30-34, 76% for ages 35-37, 66% for ages 38-39 and 52% for ages 40-45. Drop-out analysis in the latter subgroup showed that only one patient discontinued treatment because of medical reasons. In contrast to age, neither indication nor ovarian stimulation protocol had any significant effect on the delivery rate. CONCLUSIONS: Our study corroborates the impact of age on donor insemination outcome. Nevertheless, even in some older age subgroups, acceptable expected cumulative delivery rates were observed. Despite this, the main reason for discontinuing treatment, however, was the anticipated low success rate. Women, up until 42 years of age, could be encouraged to continue treatment.
