Intracytoplasmic Sperm Injection (ICSI) – What are the Risks?

Abstract

In vitro fertilization (IVF) used in combination with intracytoplasmic sperm injection (IVF/ICSI) allows otherwise sterile couples to become parents. Despite the fact that the oldest IVF conceived baby 1 is now over 30 years of age, questions about the safety of assisted reproductive technologies persist. The long term follow-up of the first generation of IVF/ICSI offspring offers a clearer picture of the safety of these technologies; despite these recent studies, however, there is still only an incomplete picture of the risks associated with the usage of these assisted reproductive techniques (ART) to offspring. The risk of multiple gestation continues to be of major concern because of its association with low birth weight, preterm delivery and increased perinatal mortality. Other ART outcomes typically assessed include: 1) congenital abnormality 2) developmental delay or abnormality 3) hormonal dysfunction 4) epigenetic effect. Existing maternal or paternal factors may confound any analysis of ART and spontaneous conception cohorts making it difficult to draw firm conclusions. This review outlines the risks associated with IVF/ICSI as a well defined treatment for couples with severe male factor infertility. Importantly, no discussion of the risks associated with IVF/ICSI can be conducted outside of the context of the existing IVF safety data. As such, both the safety of IVF and IVF/ICSI are considered here. Overall, the total body of data points to the conclusion that ICSI conceived children are at a higher absolute risk of the following conditions: 1) multiple gestation and its associated sequelae, 2) congenital defects (in particular genitourinary defects), and 3) epigenetic syndromes (such as Beckwith Wiedemann). Nevertheless, the absolute incidence of these events remains rare.

Sedimentation properties in density gradients correspond with levels of sperm DNA fragmentation, chromatin compaction and binding affinity to hyaluronic acid

“…<A>Discussion At present, assisted reproductive techniques (such as ICSI and IVF) account for about 5% of births in the Western world (Lewis and Kumar, 2015) and, with ICSI, some checkpoints of natural fertilization are bypassed. As a result, low-quality spermatozoa with features such as abnormal morphology, low motility, damaged DNA, aneuploidy and poor zona binding potential that are not normally able to participate in natural fertilization, may be selected for ICSI procedure inadvertently (Cummins and Jequier, 1995;Tournaye, 2003;Alukal and Lamb, 2008). As spermatozoa have no mechanism to repair DNA damage, DNA strand breaks can be transferred to the oocyte during ICSI, and will rely on the oocyte to repair them (Lewis and Kumar, 2015).…”

What is New in the Clinical Assessment and Treatment of the Infertile Male

“…So far, however, follow-up studies of children born after ICSI compared with children born after conventional IVF have not been conclusive regarding the risks of congenital malformations, imprinting diseases and health problems. In vitro fertilization, in general, is associated with multiple gestations and increased risk of congenital abnormalities (including hypospadias) [29]. ICSI, in particular, carries an increased risk of endocrine abnormalities, as well as epigenetic imprinting effects [29].…”

“…In vitro fertilization, in general, is associated with multiple gestations and increased risk of congenital abnormalities (including hypospadias) [29]. ICSI, in particular, carries an increased risk of endocrine abnormalities, as well as epigenetic imprinting effects [29]. Although the absolute risk of any of these conditions remains low, current data is limited and study populations are heterogenic [29][30][31][32].…”

“…ICSI, in particular, carries an increased risk of endocrine abnormalities, as well as epigenetic imprinting effects [29]. Although the absolute risk of any of these conditions remains low, current data is limited and study populations are heterogenic [29][30][31][32]. It is therefore recommended that well-defined groups of ICSI with ejaculated sperm, ICSI with epididymal sperm and ICSI with testicular sperm, and a control group of naturally conceived children are closely followed up.…”

Pre-implantation genetic testing for hereditary pulmonary arterial hypertension: promise and caution

“…Furthermore, IVF is not harmless and has been reported to be associated with complications including higher incidence of multiple births and a low but discrete risk of other genetic disorders. Several studies have shown that IVF performed by ICSI carries a higher risk of a major birth defect (in particular, genitourinary defects and epigenetic syndromes such as Beckwith-Wiedemann syndrome and Silver-Russell dwarfism) compared with a naturally conceived infant [6,[8][9][10]. The American Society of Reproductive Medicine considers ICSI a safe and effective procedure but notes that it may carry some increased risk for the transmission of selected genetic abnormalities to offspring [11].…”