Human Reproduction Update Advance Access originally published online on July 14, 2007
Human Reproduction Update 2007 13(6):515-526; doi:10.1093/humupd/dmm024
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Intracytoplasmic sperm injection (ICSI) in 2006: Evidence and Evolution
Correspondence address. P.G. Crosignani, II Department of Obstetrics and Gynecology, University of Milano, Via Commenda 12, 20122 Milano, Italy. Tel: +39-025-032-0256; Fax: +39-025-032-0255; E-mail: piergiorgio.crosignani{at}unimi.it
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 has dramatically changed the management of severe male infertility. In severe male infertility, live birth rates with ICSI are superior to those with other non-donor treatments. In non-male infertility, however, pregnancy rates are not better with ICSI than with in vitro fertilization (IVF). With obstructive or non-obstructive azoospermia, reasonable pregnancy rates are now possible with ICSI after recovery of sperm from the testes followed by ICSI. Genetic counselling is indicated for severe male infertility, whether or not ICSI is considered. ICSI is indicated in preimplantation genetic diagnosis (PGD) to avoid contamination by extraneous DNA in the case of PCR-based testing and to increase the number of embryos available for testing. In turn, PGD may be indicated in pregnancies that are at high risk of aneuploidy because of genetic factors associated with azoospermia. As with IVF, not all couples succeed, but 2% of couples with failed ICSI cycles will conceive without treatment. ICSI outcome studies indicate that there is a significant increase in prematurity, low birthweight, and perinatal mortality associated with single and multiple births, similar to the outcomes of conventional IVF. However, as evidenced in long-term follow-up studies, the higher rates of urogenital abnormalities and increased use of healthcare may be associated with paternal characteristics.
Key words: intracytoplasmic sperm injection / male infertility / preimplantation genetic diagnosis
* A meeting was organized by ESHRE (Capri, 2–3 September 2006) with an unrestricted educational grant from Institut Biochimique SA to discuss the above subjects. The speakers included: M. Bonduelle (Centre for Medical Genetics, Universitair Ziekenhuis Vrije Universiteit Brussel, Belgium), P. Braude (Department of Women's Health, King's College London, School of Medicine at Guy's King's and St Thomas' Hospitals, London, UK), J. Collins (McMaster University, Hamilton, Canada), P. Devroey (Centre for Reproductive Medicine, Universitair Ziekenhuis Vrije Universiteit Brussel, Belgium), J.L.H. Evers (Department of Obstetrics and Gynecology, Academic Hospital Maastricht, The Netherlands), B.C.J.M. Fauser (Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands), I. Liebaers (Centre for Medical Genetics, Universitair Ziekenhuis Vrije Universiteit Brussel, Belgium), G.D. Palermo (Andrology and Assisted Fertilization, Cornell Institute for Reproductive Medicine, New York, USA), A. Templeton (Department of Obstetrics and Gynecology, University of Aberdeen, Mat. Hospital, UK). The discussants included: D.T. Baird (Centre for Reproductive Biology, University of Edinburgh, UK), J. Cohen (8 rue de Marignan, Paris, France), P.G. Crosignani (II Department of Obstetrics and Gynecology, University of Milano, Italy), E. Diczfalusy (Karolinska Institutet, Stockholm, Sweden), K. Diedrich (Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany), L. Fraser (Reproduction and Rhythms Group, School of Biomedical and Health Sciences, Kings College London, UK), L. Gianaroli (S.I.S.Me.R., Bologna, Italy), A. Glasier (Family Planning and WW Services, Edinburgh, UK), G. Ragni (U.O.C. Sterilità di Coppia ed Andrologia, Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy), A. Sunde (Department of Obstetrics and Gynecology, University of Trondheim, Norway) B. Tarlatzis (Infertility and IVF Center, Thessaloniki, Greece), A. Van Steirteghem (Centre for Reproductive Medicine, Universitair Ziekenhuis Vrije Universiteit Brussel, Belgium). The report was prepared by J. Collins (Hamilton) and P.G. Crosignani (Milano).
Received on March 12, 2007; revised May 24, 2007; accepted on June 13, 2007
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