Infertility Hand-Me-Downs

Almost 2 decades ago, a fertility technique known as intra-cytoplasmic sperm injection (ICSI) changed the face of male infertility treatment forever. Sperm and egg found themselves introduced to each other in a novel method. The sperm didn't have to fight to get to the egg. A technician injected the sperm straight into the egg, eliminating the journey which the sperm of some infertile males just can't make.

Miraculous Technology

The introduction of this technology was seen as nothing short of miraculous, since it allowed men with even severe impairment in the production of sperm—men who had been ruled sterile—to father their own biological children. Eighteen years later, ICSI is among the most common fertility techniques in use. This technique is applied to more than half of all in vitro fertilization (IVF) treatments performed within the United States. According to G. David Adamson, to date, an approximately 1 million babies have been born, worldwide, as a result of ICSI. Adamson is the director of Fertility Physicians of Northern California as well as a member of the International Committee for Monitoring Assisted Reproductive Technology.

However, as the first children born via ICSI enter puberty; one problematic side effect of ICSI technology has reared its head: ICSI has allowed parents to pass down their own genetic defects to their children. One of the most poignant examples of this is that medical experts now estimate that hundreds or thousands of boys, worldwide, have inherited the genetic error responsible for their father's infertility.  As a result, these boys will have very low sperm counts and some will not produce any sperm, which will result in their total infertility.

Fertility experts have been aware of the problem for a long time. Even in 1996, studies had begun speaking of this phenomenon. This inherited genetic error has a name: microdeletion. The defect sits on the Y chromosome, signifying that much of the chromosomal DNA is absent.

Because this Y location contains genes that are crucial to sperm production, the absence of a large chunk of chromosomal DNA means that a large number of the genes that would reside therein are missing, too. All this signifies that a man will have difficulty manufacturing sperm.  In 10% of men with very low sperm counts or below 5 million sperm per milliliter of semen, this very same Y microdeletion is the problem. A father with microdeletion always passes it down to his sons.

Unintended Consequences

This tendency to pass down genetic errors must ethically lead one to ask questions about these unintended consequences of this amazing fertility technique. As time goes by, further data is added to the body of knowledge on this higher rate of inherited genetic issues which includes chromosomes that are missing parts, chromosomes that are doubled and tripled, or chromosomes that have swapped parts in infertile couples.

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