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ICSI and genetic abnormalities

Bert Gold bgold at itsa.ucsf.edu
Tue Oct 24 22:26:48 EST 1995

[ Article crossposted from bionet.general ]
[ Author was Dr Jim Cummins ]
[ Posted on 22 Oct 1995 21:14:42 -0700 ]

At the recent Andrology in the Nineties conference in Belium there was much
debate about the use of intracytoplasmic sperm injection (ICSI) from
oligoasthenozoospermic (OAT) men and genetic risk.  Peter Vogt reported on
the increased incidence of Y-chromosome delections and sex chromosome
anomalies in such men, and there seems to be evidence of a general increase
of paternally inherited anomalies in offspring (see also the somewhat
restricted series for women of advanced maternal age reported by In't Veld
in Lancet 346: 773, 1995).

While the excellent data from the Brussels group reported by Van
Steirteghem does not give rise to urgent concern,   Moosani et al (
Fertility & Sterility 1995 64(4):811-817)  in an analysis of sperm nuclei
by fluorescence in situ hybridization report a significant increase in the
frequency of disomy for chromosome I and XY disomy for infertile men.

The take-home message is that any AOT men and their partners seeking ICSI
for infertility should be given rigorous genetic counselling and advice
about the possible consequences, especially for male offspring.   Screening
for satellite deletions in the AZF region of the Y chromosome should be
mandatory IMHO.

In Belgium now 1% of all births arise from some form of assisted
reproductive technology, and this is likely to rise, according to Frank
Comhaire.   If we assume that the incidence of infertility is 10-15% and
that now nearly all cases can be "treated" by ICSI it is logical to assume
that a similar proportion of all births will result.  Even if only 10% of
OAT men carry a risk of genetic abormality this is still a highly
disturbing scenario for the next generation.  These conditions can *only*
be transmitted iatrogenically - unlike diabetes, for example, where couples
have the choice of reproducing or not reproducing.   With the incredible
acceleration of ICSI into the "run of the mill" IVF clinics without access
to intensive genetic and paediatric services the long-term implications for
health care costs makes the low-birthweight problems of conventional IVF
babies look almost trivial.

Alarm bells are ringing, I'm afraid.

Jim "Spermatology rules o~ o~ o~ o~" Cummins

Associate Professor in Veterinary Anatomy
Murdoch University, Western Australia 6150
Tel +61-9-360 2668, Fax +61-9-310 4144
E mail <cummins at possum.murdoch.edu.au>
URL <http://Numbat.murdoch.edu.au/spermatology/spermhp.html>
The Penultimate Law "All general statements are false."

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