Infertility Time Bomb

SAN DIEGO - An extreme form of In-Vitro Fertilisation (IVF) that forces sperm into eggs is being overused and may pass on infertility to the next generation, the doctor who pioneered it has warned.

Normal IVF treatment is where the sperm and eggs are mixed together in a dish and the sperm breaks into the egg on its own in order for fertilisation to occur.

The newer more advanced method, called Intra-cytoplasmic sperm injection (ICSI), involves the embryologist injecting a single sperm directly through the shell of the egg and depositing it inside. It is designed for use with poor quality or low numbers of sperm.

Abnormal sperm, that would normally be filtered out by the process, are able to fertilise the egg due to this intervention.

Since its introduction in 1992, increasing numbers of fertility clinics have adopted ICSI. In Europe, some two-thirds of fertility treatments use ISCI as compared to 10 years ago when it accounted for just one-third.

However some experts have concerns about the treatment. Since it overcomes the barrier of male infertility, there are fears that genetic defects, which would normally prevent conception, might be allowed into the embryo.

The first ICSI pregnancies 18 years ago were achieved by a Belgian team led by Professor Andre Van Steirteghem from the University of Brussels.

Speaking at a major science conference in San Diego, California, he said: "I have noticed from the beginning that several clinics use ICSI for everyone.

"I don't think it's necessary when you have methods like conventional IVF which is certainly less invasive, and can help couples with female factor or idiopathic (no known cause) infertility when the sperm count is normal," said Prof Van Steirteghem. "I don't see any reason why ICSI should be used in these situations."

Asked if he believed IVF might be storing up infertility problems for future generations, Prof Van Steirteghem said: "Well, yes. The answer to that is maybe yes.

One study discussed at the meeting looked at specific genetic changes in IVF children compared with children conceived naturally.

The research, led by Professor Carmen Sapienza, from Temple University Medical School in Philadelphia, screened around 700 genes searching for evidence of a chemical effect called methylation that can silence DNA.

In the vast majority of cases, no differences between the two groups were seen. However, for a few IVF children, 5 to 10 per cent of the genes had methylation rates outside the normal range. Some of these genes were involved in the development of fat tissue and glucose metabolism.

"It will be interesting to monitor these children to determine whether they have higher rates of obesity or diabetes," said Prof Sapienza.

A spokesman for the Human Fertilisation and Embryology Authority, the fertility regulator in the United Kingdom, said: "All clinics should make patients aware of the risks of ICSI, this is especially true of those that make a high use of this form of treatment." The Daily Telegraph