Raising The ICSI Bar
While the experts are divided on the exact nature and prevalence of birth defects that occur as a result of IVF and ICSI, it doesn't seem reasonable to place a ban on these miraculous technologies since a large majority of ICSI or IVF children seem to be just fine. On the other hand, think about how the FDA would handle a medication that caused a similar increase in birth defect rates?
But perhaps we need to set our sights further afield. It's easy to see why IVF and ICSI are still worthy techniques, considering that only 2 kids in every 100 will be found to have a birth defect as a result of ICSI. What's wrong here is that the experts are aware that a dad missing DNA in the Y chromosome is absolutely going to hand it down to his son as a result of ICSI.
A significant number of males with very low sperm counts exhibit genetic errors. For this reason, men should not be allowed to undergo ICSI without being fully tested. The most common genetic error that is passed down is Y chromosome microdeletion, in which a large part of the Y chromosome is missing in the place where some crucial sex genes would have been located. This is always handed down to sons.
But this isn't the only heritable issue with ICSI. Some 3% of infertile males have a condition known as Klinefelter syndrome as the result of an extra X chromosome. This condition causes (in addition to infertility), certain cognitive disabilities including learning problems, physical defects, and a higher rate of psychiatric illness. Most men don't even realize they have this syndrome until they end up at an IVF clinic because of fertility problems. While the majority of those with Klinefelter syndrome cannot produce sperm, some can and will be encouraged to try ICSI. The result is the possibility of fathering children who have this syndrome and other chromosomal issues.
It's important to note that it's easy to test for most chromosomal abnormalities. A simple blood test is all that's needed. Urology and fertility societies do urge men with very low sperm counts to have such tests before having the ICSI procedure. The problem is that most of the time, this advice is ignored.
In one very painfully moving true story, physicians at the Children’s Hospital of Philadelphia reported an ICSI baby born in 2008 who inherited a defective Y chromosome. The baby's specific defect is known as ring chromosome, and was the reason behind the father's extra low sperm counts. This might have been detected with ease if only a simple blood test had been performed. As a result of this oversight, ICSI was performed and the resultant infant born with both male and female sexual organs. The condition necessitated surgery to remove the male organs so that the baby could be assigned as a female.