ICSI Is a Revolutionary Treatment of Male Infertility That Should Be Employed Discriminately and Further Studied

Abstract

The development of intracytoplasmic sperm injection (ICSI) as treatment of male infertility has revolutionized infertility therapy and allowed many couples to give birth to a child that otherwise would have been impossible. However, studies have demonstrated distinct differences in the fertilization process between ICSI and standard fertilization. These differences include altered sperm chromatin decondensation, differences in the function of sperm-derived enzymes, altered gene expression of resulting embryos, and a decreased number of cells in the inner cell mass and trophectoderm. Recent studies highlight the potential effects of subtle differences in fertilization processes on the potential to alter downstream events, including epigenetic mechanisms, although it is not yet known if such differences are clinically relevant in increasing risk to offspring. Given that we are now beginning to better understand the potential effects of subtle epigenetic abnormalities and variations in affecting gene expression and health, and given the possibility that such differences may not be demonstrated in phenotypic differences until the offspring reaches a later stage of life, the long-term safety of ICSI has yet to be demonstrated. Medical and scientific prudence demand that until long-term follow-up studies of ICSI offspring are completed, caution should be taken in utilizing ICSI. Furthermore, current data demonstrate that universal use of ICSI does not result in an improved pregnancy rate or decreased risk of fertilization failure. Therefore, discriminate use of ICSI should be standard medical practice and ICSI should only be implemented when justified by documented medical necessity.