Intracytoplasmic sperm injection: offering hope for a term pregnancy and a healthy child?

Intracytoplasmic sperm injection: offering hope for a term pregnancy and a healthy child?We need a common approach to definition and detection of birth defects O ne of the most recent techniques of assisted reproduction, intracytoplasmic sperm injection, offers hope for those suffering from subfertility, and particularly male factor infertility.This hope is tempered by worry, since couples who undergo this procedure might never become pregnant or, if they do, may not carry the pregnancy to term.Added to these known risks are theoretical risks regarding birth defects: intracytoplasmic sperm injection involves fertility drugs, chemical baths, and physical procedures, any of which could increase malformation rates.Moreover, if left to nature, the sperm manipulated by this procedure would probably not produce a pregnancy, and these sperm themselves may carry an increased risk for birth defects.Some reassurance about these theoretical concerns was offered recently when researchers from Belgium reported that major birth defects affected only 3.3% (14) of 423 children born after intracytoplasmic sperm injection, 1 a rate no higher than in the general population.In the current issue, however, Kurinczuk and Bower provide a less reassuring interpretation. 2 Using the classification scheme and data from the highly regarded Western Australia birth defects registry, they note that many major defects in the Belgian series had been incorrectly classified as minor.Reclassification yielded 31 major defects, or 7.38%; compared with the Western Australian rate of 3.78%, the risk of major defects following intracytoplasmic sperm injection was increased twofold.Although the Belgian group has expanded its experience to 877 children, with an overall major malformation rate of 2.6%, 3 these later findings are based on the same analytic approach and may similarly be called into question.On the other hand, researchers from New York recently found only nine major malformations among 578 babies born after intracytoplasmic sperm injection, 4 a rate of only 1.6%-less than half that in Western Australia.Even if the six minor defects they identified were reclassified as major, the resulting rate of 2.6% is still below the expected.Do these findings suggest that birth defect risks can be minimised if couples undergo this procedure in New York rather than Belgium, or might something else explain these discrepant results?The Western Australia researchers correctly argue that for comparisons of birth defect rates to be valid, investigators must use the same definition of what Correction Attention deficit hyperactivity disorder