Comparison of ICSI and Spontaneous Pregnancy Outcomes in Women with Unexplained Infertility

Year 2024, , 135 - 138, 30.08.2024

Alper Başbuğ , Engin Yurtçu , Betül Keyif , Fatma Nur Düzenli

https://doi.org/10.18678/dtfd.1458126

Abstract

Aim: This study aimed to investigate whether there is a difference between the results of intracytoplasmic sperm injection (ICSI) pregnancies and subsequent spontaneous pregnancies with a diagnosis of unexplained infertility.
Material and Methods: In this retrospective study, a total of 48 women who first conceived with ICSI and then achieved spontaneous pregnancy were included. Duration and causes of infertility, time to spontaneous conception, pregnancy outcomes, and maternal and neonatal complications were evaluated.
Results: Maternal age was older in the spontaneous pregnancy group compared to the ICSI group (p=0.029). The gestational age at delivery was found similar in both groups. Although birth weight was higher in the spontaneous pregnancy group, the difference between the groups was not statistically significant (p=0.382). The time to achieve pregnancy was shorter in the spontaneous pregnancy group (p=0.001). Gestational diabetes was significantly higher in the spontaneous pregnancy group (p=0.001), while amniotic fluid abnormality, gestational hypertension (p=0.001), and preterm delivery (p=0.001) were significantly higher in the ICSI group. While the number of babies with the 1st-minute low Apgar score was higher in the ICSI group (%4.16 vs 2.08%, p=0.001), the 5th-minute Apgar score was similar.
Conclusion: Even if couples are evaluated as infertile, it should be taken into consideration that they can achieve spontaneous pregnancy. It may be rational to wait for spontaneous pregnancy in eligible couples with unexplained infertility and not to refer the patient for early assisted reproductive techniques.

Keywords

ICSI, spotan pregnancy, pregnancy outcomes, unexplained infertility

Açıklanamayan İnfertilite Tanısı Almış Kadınların ICSI ve Spontan Gebelik Sonuçlarının Karşılaştırılması

Abstract

Amaç: Bu çalışmada, açıklanmayan infertilite tanısı alarak intrasitoplazmik sperm enjeksiyonu (intracytoplasmic sperm injection, ICSI) ile elde edilen gebelikler ile daha sonradan elde edilen spontan gebeliklerin sonuçları arasında bir farklılık olup olmadığının incelenmesi amaçlanmıştır.
Gereç ve Yöntemler: Retrospektif nitelikteki bu çalışmaya önce ICSI ile gebe kalmış ve sonrasında ise spontan gebelik elde etmiş olan toplam 48 kadın dahil edildi. İnfertilite süreleri ve nedenleri, spontan gebelik elde etmek geçen süre, gebelik sonuçları ile maternal ve neonatal komplikasyonları değerlendirildi.
Bulgular: ICSI grubu ile karşılaştırıldığında, maternal yaş spontan gebelik grubunda daha büyüktü (p=0,029). Doğum anındaki gebelik haftası her iki grupta benzer bulundu. Spontan gebelik grubunda doğum ağırlığı daha yüksek olmasına rağmen gruplar arasındaki fark istatistiksel olarak anlamdı değildi (p=0,382). Gebelik elde etmek için geçen süre spontan gebelik grubunda daha kısaydı (p=0,001). Gestasyonel diyabet spontan gebelik grubunda daha yüksek iken (p=0,001), amnion mai anormalliği, gestasyonel hipertansiyon (p=0,001) ve preterm doğum (p=0,001) ICSI grubunda anlamlı olarak daha yüksekti. 1. dakika düşük Apgar skoru olan bebek sayısı ICSI grubunda daha yüksekken (%4,16’ya karşı %2,08 p=0,001), 5. dakika Apgar skoru benzerdi.
Sonuç: Çiftler infertil olarak değerlendirilse bile sonrasında spontan gebelik elde edebilecekleri göz önünde bulundurulmalıdır. Açıklanamayan infertilite tanısı almış uygun çiftlerde spontan gebelik için beklemek ve hastayı erkenden üremeye yardımcı teknikler için yönlendirmemek akılcı bir tutum olabilir.

Keywords

ICSI, spotan gebelik, gebelik sonuçları, açıklanamayan infertilite

References

• Evers JL. Female subfertility. Lancet. 2002 13;360(9327):151-9.
• Cox CM, Thoma ME, Tchangalova N, Mburu G, Bornstein MJ, Johnson CL, et al. Infertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis. Hum Reprod Open. 2022;2022(4):hoac051.
• Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22(6):1506-12.
• Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.
• Gore AC, Chappell VA, Fenton SE, Flaws JA, Nadal A, Prins GS, et al. EDC-2: The Endocrine Society's Second Scientific Statement on Endocrine-Disrupting Chemicals. Endocr Rev. 2015;36(6):E1-150.
• Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37.
• Ludwig AK, Katalinic A, Jendrysik J, Thyen U, Sutcliffe AG, Diedrich K, et al. Spontaneous pregnancy after successful ICSI treatment: evaluation of risk factors in 899 families in Germany. Reprod Biomed Online. 2008;17(3):403-9.
• Hennelly B, Harrison RF, Kelly J, Jacob S, Barrett T. Spontaneous conception after a successful attempt at in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril. 2000;73(4):774‑8.
• Silberstein T, Levy A, Harlev A, Saphier O, Sheiner E. Perinatal outcome of pregnancies following in vitro fertilization and ovulation induction. J Matern Fetal Neonatal Med. 2014;27(13):1316-9.
• Mack LR, Tomich PG. Gestational diabetes: diagnosis, classification, and clinical care. Obstet Gynecol Clin North Am. 2017;44(2):207-17.
• Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014;4(2):97-104.
• Gestational hypertension and preeclampsia: ACOG Practice Bulletin, number 222. Obstet Gynecol. 2020;135(6):e237-60.
• Hayashi M, Nakai A, Satoh S, Matsuda Y. Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used. Fertil Steril. 2012;98(4):922-8.
• Romundstad LB, Romundstad PR, Sunde A, von Düring V, Skjaerven R, Gunnell D, et al. Effects of technology or maternal factors on perinatal outcome after assisted fertilisation: a population-based cohort study. Lancet. 2008;372(9640):737-43.
• Raatikainen K, Kuivasaari-Pirinen P, Hippeläinen M, Heinonen S. Comparison of the pregnancy outcomes of subfertile women after infertility treatment and in naturally conceived pregnancies. Hum Reprod. 2012;27(4):1162-9.