Craving the Genetic Link and the Rise of ICSI

There’s been a great deal of discussion here about the importance of/significance of  a genetic link between parent and child.  (You can go back to the post before last to get a taste of the discussion, or you can try out some of the tags.)   While pondering those issues I noticed a recent panel on assisted reproductive technology (ART) at the American Association for the advancement of Science (AAAS) annual meeting.   

There was a discussion of the concerns arising from increasing use of a intracytoplasmic sperm injection–otherwise known as ICSI.  (That’s pronounced “ick-see,” if you are wondering.)   In ICSI an embryologist injects a single sperm into an egg in the hopes of spurring conception.   

There’s a striking chart on the pages of the Human Fertilisation and Embryology Authority (the UK regulating agency) that shows the increasing use of ICSI.   (I’m not at all clear about how one can do ICSI alone–as I understand it, ICSI must be coupled with IVF, because the sperm is injected into the egg outside the woman’s body and then the fertilized egg is transferred into her uterus.   But I’m just going to skip this confusion.)   It’s harder to find statistics for the US (and if anyone wants to point me to some, so much the better) but I’m confident they’d show the same trend.    

Now the discussion at the AAAS suggests there is good reason to be concerned about the rising use of ICSI.    Abnormal sperm, that would not have been able to fertilze an egg under ordinary circumstances, may be used for conception in ICSI.  The resulting offspring may be at increased risk of genetic abnormalities.  

The scientists quoted in the article suggest that the use of ICSI has become too routinized–and indeed, the chart I linked to suggests that its use is routine in IVF.    (I suppose it is viewed as insurance that fertilization will occur.)     And the proposed solution is to restrict its use to instances where it is necessary–where sperm motility is low, for example.  

But it seems to me that cases where the man’s sperm is generally unhealthy are those most likely to generate the problematic result.    In view of these risks, why is ICSI use flourishing?  

The answer, it seems to me, is that it allows a heterosexual couple who might previously have used donor sperm to create a child that is genetically related to both parents.   Whatever the risk, it’s worth it to people in order to have a child that is genetically related to her/his father.   This strikes me as a terribly problematic calculation.  

\

(Some of the papers from the panel generated some mainstream media coverage, too.)

Advertisements

8 responses to “Craving the Genetic Link and the Rise of ICSI

  1. I think “ICSI only” must mean IVF cycle with ICSI, “IVF only” means IVF without ICSI, and “IVF & ICSI” means the sum of the two groups.

    I don’t know all the different reasons for low sperm motility, but if a man has a *specific* problem with motility, meaning the chromosomes inside the sperm are fine, then that is a perfect case for ICSI.

    A problem with ICSI, and maybe with IVF as well, is that we don’t always know the difference between a generally “sick” gamete, which may have a problems that could affect the child later in life, and a gamete that just has a problem with the mechanics of fertilization.

    Interestingly, our fertility clinic offered us ICSI even though we were using donor sperm — we declined because it is such a new technique.

    With the low success rate of these expensive interventions, it’s tempting to both doctors and patients to try anything that will improve the outcomes a bit.

    • I think you must be right. It’s just odd that the words “ICSI only” mean IVF with ICSI. Surely they could have labelled things a bit more clearly.

      I was surprised to learn that ICSI has become fairly standard, even in cases where there aren’t specific concerns about motility, etc. I suspect a combination of two factors explains this. As you say, the difficult of ART generally means people want to maximize the chances it will work each try. I suspect in addition there is a financial incentive for the provider–more services means more fees. But perhaps that last is too cynical.

  2. I think ICSI only means that only ICSI is used rather than allowing some eggs to fertilize naturally in the medium by adding sperm. Some clinics will do most eggs as regular IVF and a couple of eggs with ICSI as an added insurance.

  3. In my own case the doctor recommended ICSI because of my age (41) saying that it would increase likelihood of successful fertilization of my eggs, even though sperm motility was in the “normal” range. I relied on my doctor’s advice, but I had to wonder if part of the motivation was not the extra $2000 I paid for the proceedure.

  4. The frequency of ICSI isn’t just the added fees, but also the added success rate. The all-important success rate is the cause of a lot of questionable practices, because let’s face it, patients often (if not mostly) choose their provider based on that little number. Any place you can increase odds is an avenue that needs explored, according to many patients and providers. If that means increased odds of multiples, genetic abnormalities, whatever- so be it.

    • That’s a helpful point. I’m sure prospective patients would care about success rates as they shop for services.

      The more I consider it, the more it seems the incentives are just set up in a way that is quite problematic.

      • The incentives are set in a very troubling manner. A child’s health- physical and psychological- may not be the best place to allow free market capitalism run wild, which is essentially what we have with ART right now. Add in the problems of our current health insurance system (differences of coverage, exclusions, terminations, rate hikes, etc.) and the risks are extremely high. At the same time that we increase risks for the children conceived via new technology, we stigmatize adoption and fostering because of the idea that “anyone can have a child thanks to medical advances”. Potential parents really need to be asking themselves the hard questions beyond “how can we have a child” and into the realm of “should we have this child”. And I mean that for potential parents by all means, not just those suffering infertility.

        • It’s interesting to think about the reasons why people choose some of the extenstive/expensive and taxing ART treatments over adoption. Partly it’s because of the genetic link, of course. People want a child that is truly “theirs.” I’m sure some, maybe many, women want the experience of being pregnant giving birth. (I suspect this is in part because of the way our culture portrays it as an essential female experience.) I also think people believe you have more control over the kind of child you get when you grow your own, as it were. But the new information about children concieved via some of these methods suggests that this last is not always as true as people think.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s