Intracytoplasmic sperm injection

Male factors are the commonest single cause of infertility (1).

• the technique of intracytoplasmic sperm injection (ICSI) has revolutionised the treatment of patients with moderate to severe oligoasthenoteratozoospermia and other sperm dysfunctions; it has also enabled treatment of patients with azoospermia (either resulting from non-obstructive or obstructive origin) via the surgical retrieval of testicular or epididymal spermatozoa
• it has been suggested that ICSI results in a slight, but significant, increased incidence of sex chromosomal abnormalities in children born as a result of ICSI (2). However a case-control study by AG Sutcliffe et al (3), of neurodevelopmental delay among children in their 2nd year of life who have been conceived via ICSI, showed no difference between the 2 groups. Also congenital abnormality rates were similar between the 2 groups - however there was a trend to a slightly higher incidence of congenital abnormalities (particularly of the genital tract) in children born to fathers with azoospermia
• ICSI has been used as a treatment option in non-male-factor infertility

NICE suggest that (4):

• Intracytoplasmic sperm injection Intracytoplasmic sperm injection versus IVF
  • Indications for intracytoplasmic sperm injection
    • recognised indications for treatment by ICSI include:
      • severe deficits in semen quality
      • obstructive azoospermia
      • non-obstructive azoospermia
    • In addition, treatment by ICSI should be considered for couples in whom a previous IVF treatment cycle has resulted in failed or very poor fertilisation
  • couples should be informed that ICSI improves fertilisation rates compared to IVF alone, but once fertilisation is achieved the pregnancy rate is no better than with IVF

Reference:

• (1) Irvine DS (1998). Epidemiology and etiology of male infertility. Hum Reprod, 13 (suppl 1), 31-44.
• (2) Bonduelle M et al (1999). Seven years of ICSI and follow-up of 1987 subsequent children. Huma Reprod, 14 (suppl), 243-64.
• (3) Sutcliffe AG et al (2001). Outcome in the second year of life after in-vitro fertilisation by intracytoplasmic sperm injection. Lancet, 357 (9274), 2080-4.
• (4) NICE (February 2013).Fertility - Assessment and treatment for people with fertility problems