Possibilities and limits of assisted reproduction

: The term assisted reproductive technologies (ART) describes all treatment procedures which include more than the natural intercourse to conceive. The most invasive procedure is intracytoplasmic sperm injection (ICSI), which was introduced in 1993. By ICSI the successful treatment of couples with severe male factor infertility, even in cases of azoospermia, became possible. In cases where only immature forms of spermatogenesis are present in the testicular tissue, pregnancies could also be achieved. The limiting factor with greatest influence on the success rate of ART procedures is the female's age. In this context the treatment of postmenopausal women by oocyte donation, as well as ooplasma donation to overcome the negative influence of the female's age on oocyte quality are extreme examples of ethically questionable ART procedures. Until now several 100,000 children worldwide have been born subsequent to ART and especially in vitro fertilisation. No increase in the malformation rate neither after IVF nor after IVF/ICSI have been reported so far. However, because of the lack of prospective controlled studies using standardised evaluation procedures and having enough statistical power to prove the security of ICSI for the newborn children, the German statutory health insurance bodies have ceased to pay ICSI costs as of July 1999. The data on the success of ICSI, the known data on the newborn and developing children and the decisions of the medical services of the German statutory health insurance bodies are presented in discussed in this paper.