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ICSI: the end of male sterility?

letto 7137 volte | autore: Claudio Manna, ginecologo specialista in fecondazione assistita (vai al curriculum)


The intracytoplasmic injection of spermatozoa has rapidly demonstrated its stupefying efficacy.

The last born of the assisted procreation techniques, the intracytoplasmic sperm injection has rapidly demonstrated its stupefying efficacy.  The benefits of assisted reproductive techniques do not have to be demonstrated because they are responsible for tens of thousands of births worldwide each year. Nevertheless, some recent methods are attacked because of their potential dangers.  This is the case of ICSI.  Lets see why.

ICSI is the result of a biologists error. Researchers were trying to evaluate the benefits of the direct nearing of the spermatozoa to the membrane of the ova within a not very efficient technique called SUZY (sub-zonal insemination), which should have allowed fertilisation with originally non fertilising sperm.  During one of the manoeuvres one of the biologists made a sperm to penetrate into the cytoplasm of the ovum, and from this accidental manoeuvre a child was born in 1992.  This method has had increasing success in the last few years and it alone represents more than 35% of all the methods of assisted fertilisation in the world.  ICSI allows couples who are infertile for male reasons to become pregnant, conditions for which no solution existed apart from using donor sperm, and above all the success rate of ICSI is higher than that of a traditional FIVET which generally has a 25% success rate.  According to studies at the University of Brussels the success rate of ICSI is 33% higher if the woman is less than 37 years old allowing 80% of infertile couples affected by male sterility to become pregnant.  Even though thousands of children have been born as a result of  it, some governments have contested that abuse has occurred by the proposal of ICSI to patients who could have resorted to classical FIVET or simple surgical treatments.  To combat this, some states have established that ICSI can only be adopted by couples whose probabilities of success with traditional FIVET are considered very low.

Violation of the ovule or a helping hand to destiny?
ICSI involves injecting the spermatozoon directly into the ovule, and is used in instances of grave abnormalities of the sperm.  Some scientists are asking themselves about the possible consequences of this technique.  On one hand, the biologist himself chooses the spermatozoon to directly inject into the ova, this could however have defects and were fertilisation to take place “naturally” this would be rejected; on the other hand, the consequences of his manipulation, that is the eventual trauma suffered by the ovule, are mainly unknown.  An American study should, however, lessen the anxiety of the detractors of ICSI: the study, published by the prestigious magazine The Lancet, demonstrates that children born through ICSI develop completely normally.  Statistically speaking, after ICSI, only caesarean and premature births increase, nevertheless the numbers are not significantly different from the rest of the population.

Some months later (February 2002) the same magazine published a study by a group of  Swedish researchers who, however, reached completely different conclusions.  Even though you cannot isolate children born as a result of ICSI from those born as a result of other assisted fertilisation techniques, the researchers estimate that children born from ICSI run higher risks of cerebral diseases than children born as a result of spontaneous pregnancies.  To reach this conclusion the experts compared the frequency of neurological problems of 5.680 children born as a result of in vitro fertilisation will 11.360 conceived naturally and these are the results: the children born from this technique run the risk of developing  neurological problems, in particular cerebral palsy.  These risks are above all caused by the complications of multiple pregnancies and relative premature births of children born as a result of FIVET and not because of the technique itself.  To reduce these risks it is recommended that only one embryo is implanted during every cycle of in vitro fertilisation.  The number of embryos transferred, however, influences success as we have seen.  Assisted procreation centres, therefore, have for some years now limited themselves to the transfer of  2 or maximum 3 embryos.


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venerdì 21 marzo 2008

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