As well as to eliminate sperm contamination, ICSI will be required for male cystic fibrosis carriers that have congenital absence of the vas deferens and sperm aspiration is required to obtain the sperm and ICSI for efficient fertilization (see Chapter 5). In some cases of chromosomal translocations, a low sperm count may be present and the use of ICSI required to obtain fertilization. Males with Y chromosome deletions will also require ICSI (Figure 8.9).
Figure 8.9 Intracytoplasmic spermatozoa injection
There have been reports that ICSI is associated with an increase in birth defects. Kurinczuk and Bower (1997) reported a two-fold increase (odds ratio 2.03, 95% confidence interval 1.4 to 2.93) in birth defects in 420 infants liveborn after ICSI and nearly 50% higher incidence of a minor defect (odds ratio 1.49, 95% confidence interval 0.48 to 4.66). Their results differed from the Belgian group (Bonduelle et al., 1996) who used a narrow definition of what constituted a birth defect and who concluded that there was no increase in the occurrence of major birth defects among infants conceived by ICSI. The ESHRE Task Force reported the outcome of 13666 cycles of ICSI carried out in 1994 by 90 centres in 24 countries (ESHRE Task Force on Intracytoplasmic sperm injection, 1998). A total of 455 pre- and postnatal karyotypes revealed the presence of 9 abnormal karyotypes. In 4 out of 9 cases, the abnormal karyotype was related to paternal factors in severe male infertility. Twenty-four centres reported on 807 ICSI children. Sixteen major congenital malformations were reported. A widely accepted definition of major malformation was applied, i.e. malformations that generally cause functional impairment or require surgical correction. Further research is needed to elucidate these results, but meanwhile they should be borne in mind when counselling couples about ICSI.
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