Received July 07, 2020
Accepted May 10, 2021

Introduction:Some studies have shown that ART babies tend to present more congenital-malformations than naturally conceived children, and ICSI offspring can reach about 6.5% of birth defects. The use of high magnification sperm selection before ICSI, was introduced in the early 2000s, and allows the identification of spermatozoa with low risk of sperm DNA damage. Therefore, the use of IMSI could change the incidence of congenital-malformations. Despite this, data on its association with birth defects in children conceived after IMSI are still scarce. Methods:A systematic review based on electronic searches of databases up to May 2020 was conducted to identify trails comparing the neonatal outcomes of ICSI versus IMSI techniques. The outcome measured was birth-defects rates in children born after ICSI or IMSI. Three trials were included as targets for data-extraction and meta-analysis. Results:The meta-analysis included 3907 children conceived after IMSI (1280) or ICSI (2627), and the incidence of total birth-defects was 2.5% (32/1280) when IMSI approach was used and 4.5%(119/2627) when the ICSI technique was employed, with significant statistical difference (RR=0.60; 95%CI=0.41-0.88;p<0.01).We performed the isolated analysis of structural-defects and chromosomal-abnormalities. The results demonstrated that the use of IMSI reduces the incidence of structural-defects compared to ICSI, 2.2%(18/830) versus 3.8%(78/2049), with statistical significant difference (RR=0.58; 95%CI=0.35-0.97;p=0.04). Regarding the chromosomal-abnormalities there was no statistically significant difference between the children conceived after IMSI (8/830) or ICSI (19/2049) (RR=1.08; 95%CI=0.47-2.45;p=0.8). Conclusion:IMSI seems to be an effective-tool in reducing the incidence of structual-defects compared to ICSI. However, IMSI does not change the incidence of chromosomal-abnormalities