Can Fertility Treatments be Over-used?
According to the scientist who developed one of the most widely used types of fertility treatments for infertile men, his technique is used too frequently. The fertility clinics that are over-using intra-cytoplasmic sperm injection (ICSI) as a means of helping men realize their dreams of fatherhood, are putting their patients at unnecessary risk and expense.
The Numbers Tell the Story
In 1991 Andre van Steirteghem of the Free University of Brussels led the team that invented the ICSI procedure. The revolutionary treatment involving the injecting of a sperm directly into an egg rescued men with poor-quality sperm from the despair of not being able to produce their own biological children. However, by all accounts, the treatment is being used inappropriately and indiscriminately on couples who don't need it.
In Europe, in just over a decade, (1995-2007) the number of in vitro fertilization cycles involving ICSI have increased by 66% and in the UK, in the same period of time, ICSI usage rose from 15% to 48% of IVF cycles, with even higher percentages in some clinics. Britain's Assisted Reproduction and Gynaecology Centre in London, where the success rates of IVF are the highest, uses ICSI in 78% of treatments.
Used When it Shouldn't Be Used
Dr. van Steirteghem's concern is that ICSI is being used to treat everyone when conventional IVF, which is less invasive than ICSI, would be very suitable for men with normal sperm. Using the therapy in situations where sperm is normal is unnecessary and expensive. ICSI can cost up to 30% more than standard IVF, which costs about 3,500 Pounds without ICSI. When ICSI is added, the price goes up another 1,000 Pounds. In standard IVF procedure, the sperm are allowed to swim up to an egg in order to fertilize it. ICSI treatment injects a sperm into an egg at an increased risk for producing children with birth defects.
Risk to Little Boys
There is an added concern that children conceived with this technique using sperm that is not robust enough to fertilize an egg may encounter longer-term health problems. Boys born through ICSI are at risk for infertility when they mature since the genetic traits that weakened the father's sperm can be passed on to the child. Dr. van Steirteghem's recommendation is that children conceived using ICSI should continue to be followed up, especially since the oldest of these children are not yet twenty. There may not be any problems, but it is important to know what will come out of the therapy in the end.
What are the Contributing Factors to Over Use?
Poor motility and low sperm count are the reasons ICSI offers the best technique to use for male infertility. The fact that the clinic can guarantee the successful fertilization of more eggs, whether the male's sperm is normal or not, drives the usage up. More embryos are available for IVF use through the ICSI method.
The Human Fertilisation and Embryology Authority recommend that ICSI be used only when there are problems with the man's sperm or when previous attempts at IVF have failed. Several medical professionals concur with Dr. van Steirteghem in the assessment that the treatment is over used. Their comments noted that men are not properly evaluated before IVF. Commonly, the sperm is normal and ICSI is not necessary. The suspected fear of patients experiencing a failed attempt at fertilization using conventional IVF seems to be another reason the treatment continues to be used ahead of other forms of IVF.
The fact that so many couples pay for their own treatment, especially in the UK, makes it seem unlikely that the treatment usage will be reduced. Time will tell how great the numbers are of children negatively affected by ICSI treatment using inferior sperm.