An advanced form of in-vitro fertilization (IVF) treatment is being overused and may pass on infertility and other genetic defects to the next generation, the doctor who pioneered the technique has warned.
The method, called ‘Intra-cytoplasmic sperm injection (ICSI)’ involves injecting a single sperm cell directly through the wall of the egg and depositing it inside.
However, abnormal sperm, that would normally fail to penetrate the egg, can fertilize the egg because of this procedure, thus increasing the risk of the genetic disorder that caused the parents’ infertility to be passed on to the child.
Dr. Andre Van Steirteghem, of the Brussels Free University Centre for Reproductive Medicine, who was the leader of the team that developed ICSI nearly 20 years ago, told the American Association for the Advancement of Science (AAAS) meeting at San Diego that he believed “ICSI was being used too often.”
Van Steirteghem said that although the technique has been “invaluable in treating infertile couples when the man cannot produce viable sperm for conventional IVF, it should be used only when medically necessary.”
Since its introduction in 1992, ICSI is being used increasingly by fertility clinics because it has a higher fertilization success rate.
According to the UK Daily Mail, about half the infertility treatment cycles conducted in British clinics use this method. In Europe, two-thirds of fertility treatments are ICSI, while 10 years ago it accounted for just a third.
However, Van Steirteghem said overuse of the technique puts patients and their children at risk.
“I have noticed that several clinics use ICSI for everybody. I don’t think it is necessary when you have methods like conventional IVF which is certainly less invasive… When the sperm is normal, I don’t see any reason why ICSI should be used.”
“There are genetic causes of infertility that you can pass on,” said Dr. Van Steirteghem. “It means that the next generation may be infertile as well and this is something all clinics should mention to the patients – that if there is a genetic origin that this genetic origin of infertility may be transmitted to the next generation.”
“Several millions of children have been born around the world after reproductive technology. In some countries they represent 3 to 5 per cent of all births. Overall the children do well so this is a positive,” Dr. Van Steirteghem said. “Yet there are a few problems for these children.”
Asked whether the next generation of children are more likely to be infertile as a result of using artificial reproductive technology, Dr. Van Steirteghem said: “Well, yes, the answer to that is maybe yes. That may mean the next generation will be infertile as well. If there is a genetic origin then this may be transmitted to the next generation.”
Dr. Van Steirteghem concluded, “The health of children has to be considered the most important outcome of artificial reproductive technology treatment. It’s fair to say that overall these children do well [but] there a few more problems with these children.”
“It doesn’t mean that when you use ICSI there will be more problems, but it is important that we have to see what comes about in the future, so long-term monitoring is extremely important. ICSI has been overused.”
Several other fertility experts concerned by the abuse of ICSI concurred with Dr. Van Steirteghem.
“In the majority of IVF cases where you have functional and healthy sperm you shouldn’t have to use ICSI. The exception to that is in men who have sperm-function defects,” Dr. Dolores Lamb of Baylor College of Medicine in Houston, Texas, told the AAAS meeting.
Dr. Allan Pacey of the University of Sheffield, said “I agree that there is a real danger that ICSI is being overused in some parts of the world and I suspect this is out of fear of patients experiencing ‘failed fertilisation’ using conventional IVF.”
“The problem of over using ICSI is that there is a very small but statistically significant increased risk that some of the babies born from the technique appear to have health problems. As such the sensible thing is to only use ICSI when absolutely necessary.”