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Physische, psychische und soziale Entwicklung der nach intrazytoplasmatischer Spermieninjektion geborenen Kinder – die Deutsche ICSI-Langzeitstudie

Physical, psychological, and social development of children born after intracytoplasmic sperm injection: the German ICSI long-term study

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Journal für Gynäkologische Endokrinologie/Österreich Aims and scope

Zusammenfassung

In Deutschland werden rund 3 % aller Neugeborenen nach einer Kinderwunschbehandlung geboren. Häufigste Methode der assistierten Reproduktion (assisted reproductive technique [ART]) ist die intrazytoplasmatische Spermieninjektion (intracytoplasmic sperm injection [ICSI]). Ob es gesundheitliche Benachteiligungen bei Kindern und Jugendlichen, die nach einer ICSI-Behandlung geboren wurden, gibt, wird kontrovers diskutiert.

In der Deutschen ICSI-Langzeitstudie wurde eine Kohorte von Kindern, die nach einer ICSI-Behandlung in den Jahren 1998 bis 2000 geboren wurden, zu drei Untersuchungszeitpunkten hinsichtlich ihrer gesundheitlichen, psychischen und sozialen Entwicklung untersucht (ICSI-Studie I–III). Der Schwerpunkt der ersten Untersuchung war der Schwangerschafts- und Geburtsverlauf sowie die neonatale Gesundheit der Kinder. Im zweiten Untersuchungszeitraum (2004–2006) wurde die somatische und neurologische Entwicklung der Einlinge untersucht, während 2015–2017 (dritter Untersuchungszeitraum) die kardiometabolische und endokrinologische Entwicklung der Jugendlichen sowie deren Lebensqualität und soziale Entwicklung im Mittelpunkt standen. Insgesamt kann festgestellt werden, dass die physische und psychische Entwicklung der Kinder vergleichbar zu spontan konzipierten Gleichaltrigen verläuft. Die Fehlbildungsrate nach ICSI ist geringfügig erhöht und das Geburtsgewicht etwas niedriger als bei spontan konzipierten Kindern. Die Mehrlingsrate ist erhöht, was u. a. zu mehr Frühgeburtlichkeit mit entsprechenden Folgen führt. Unterschiede in den metabolischen Faktoren können auf ein erhöhtes Risiko für kardiovaskuläre Erkrankungen im späteren Lebensverlauf hinweisen. Ob das Verfahren der ICSI zu klinisch relevanten kardiovaskulären Risiken führt, muss in weiteren Studien untersucht werden.

Abstract

In Germany, approximately 3% of all newborns are born after infertility treatment. The most common method of assisted reproduction (ART) is intracytoplasmic sperm injection (ICSI). Whether there are health disadvantages in children and adolescents born after ICSI treatment remains controversial. The German ICSI long-term study includes a cohort of children born after ICSI treatment in 1998 and 2000. The children were examined at three points in time with regard to their health, psychological, and social development (ICSI Study I–III). The focus of the first study was the course of pregnancy and birth and the neonatal health of the children. In the second study period (2004–2006), the somatic and neurological development of the singletons was studied. In the third study (2015–2017), the focus was on the cardio-metabolic and endocrinological development of the adolescents as well as their quality of life and behavior. Overall, it can be concluded that the psychological and intellectual development of the ICSI children is comparable to spontaneously conceived peers. The malformation rate in children born after ICSI is slightly increased and the birth weight slightly lower than in spontaneously conceived children. The multiple birth rate is elevated, leading to more preterm births with corresponding consequences. Differences in metabolic factors may indicate an increased risk of cardiovascular disease later in life. Whether the procedure of ICSI leads to clinically relevant cardiovascular risks needs to be investigated in further studies.

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Authors and Affiliations

  1. Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland

    M. Schnoor, S. Elsner, N. Eisemann & A. Katalinic

  2. SYNLAB Holding Deutschland GmbH, München, Deutschland

    M. Ludwig

  3. Praxis für Frauengesundheit und Pränatalmedizin, 22763, Hamburg, Deutschland

    A. K. Ludwig

  4. Facharztzentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie, amedes experts Hamburg, Hamburg, Deutschland

    B. Sonntag

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  1. M. Schnoor
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  2. S. Elsner
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  3. M. Ludwig
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  4. A. K. Ludwig
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  6. N. Eisemann
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  7. A. Katalinic
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Correspondence to M. Schnoor.

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Interessenkonflikt

M. Schnoor, S. Elsner, M. Ludwig, A.K. Ludwig, B. Sonntag, N. Eisemann und A. Katalinic geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schnoor, M., Elsner, S., Ludwig, M. et al. Physische, psychische und soziale Entwicklung der nach intrazytoplasmatischer Spermieninjektion geborenen Kinder – die Deutsche ICSI-Langzeitstudie. J. Gynäkol. Endokrinol. AT 31, 87–93 (2021). https://doi.org/10.1007/s41974-021-00190-y

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