Genetic Problems and Congenital Malformations in 1987 ICSI Children

When assisted fertilization and intracytoplasmic sperm injection (ICSI) were introduced, there was major concern about the safety of the newly introduced technique. Intracytoplasmic sperm injection is indeed a more invasive procedure than routine IVF because one spermatozoon is injected through the oo-cyte membrane and because fertilization can be obtained from sperm that could never have been used before in fertility treatment. Even more questions arose and concern was again expressed when ICSI with nonejaculated spermatozoa, either epidididymal or testicular, was introduced. Emphasis was put on the fact that because more chromosomal aberrations are found in azoospermic males and more in particular in case of nonobstructive azoosper-mia, the risk for chromosomal aberrations in the offspring might even be higher. Other heritable genetic causes might also be involved. On the other hand, it was suspected that imprinting may be less complete at the time of fertilization if testicular sperm is used. If this were so, then it would be unlikely to impair fertilization and early development, but anomalies might become manifest at birth or only later in life.