Needle IVF method overused, pioneer warns

IVF clinics are using a radical male infertility treatment far too frequently despite the risk of long-term health problems to the babies conceived, according to one of the technique’s pioneers.

Intracytoplasmic sperm injection (ICSI) involves injecting individual sperm cells directly into an unfertilised egg to improve the chances of producing a viable embryo that can then be implanted into the woman’s womb.

Many of the medical problems associated with fertility treatment arise from more than one embryo being implanted into the womb, which brings a higher risk of multiple births and associated medical complications.

However, with injecting sperm directly into the egg, there are fears that it might increase the selection of genetically-defective sperm, resulting in problems such as heart disease, diabetes and obesity being passed on to future generations.

Andre Van Steirteghem, of the Brussels Free University Centre for Reproductive Medicine, was the leader of the team that developed ICSI nearly 20 years ago. He says that although the technique has been invaluable in treating infertile couples when the man cannot produce viable sperm for conventional IVF, it should be used only when medically necessary – and that at present many clinics routinely use ICSI even when the man can still produce enough viable sperm to fertilise an egg in an IVF test tube.

Since the first IVF baby, Louise Brown, was born in 1978, 3 million children worldwide have been conceived using the technology. ICSI use has grown particularly explosively, accounting for about half of all test-tube conceptions in Britain and two-thirds of IVF cycles in Europe.

Dr Van Steirteghem told the American Association for the Advancement of Science in San Diego: “I have noticed that several clinics use ICSI for everybody. I don’t think it is necessary when you have methods like conventional IVF which is certainly less invasive... When the sperm is normal, I don’t see any reason why ICSI should be used.

“The health of children has to be considered the most important outcome of artificial reproductive technology treatment. It’s fair to say that overall these children do well [but] there a few more problems with these children.”

He added: “It doesn’t mean that when you use ICSI there will be more problems, but it is important that we have to see what comes about in the future, so long-term monitoring is extremely important. ICSI has been overused.

He is monitoring the long-term health of about 15,000 children born as a result of artificial reproductive technology such as IVF and ICSI.

His views were supported by other fertility experts concerned by the growth of ICSI, which makes it easier for clinics to achieve a rapid and successful fertilisation of an unfertilised egg. Conventional IVF mixes a group of sperm cells with the egg to allow a more natural fertilisation with the most viable sperm being the most likely to achieve conception.

“In the majority of IVF cases where you have functional and healthy sperm you shouldn’t have to use ICSI. The exception to that is in men who have sperm-function defects,” said Dolores Lamb of Baylor College of Medicine in Houston, Texas.

Asked whether we are creating a generation of children who are more likely to be infertile as a result of using artificial reproductive technology, Dr Van Steirteghem said: “Well, yes, the answer to that is maybe yes.”

Allan Pacey, senior lecturer in andrology at the University of Sheffield, said: “I agree that there is a real danger that ICSI is being overused in some parts of the world and I suspect this is out of fear of patients experiencing 'failed fertilisation' using conventional IVF.

“The problem of over using ICSI is that there is a very small but statistically significant increased risk that some of the babies born from the technique appear to have health problems. As such the sensible thing is to only use ICSI when absolutely necessary.”