IVF treatment by injecting sperm used too often by fertility clinics

A technique for injecting sperm directly into unfertilised eggs to increase the chances of a successful IVF pregnancy is being used too widely by some fertility clinics, the head of the Government's fertility watchdog has warned. Lisa Jardine, who chairs the Human Fertilisation and Embryology Authority (HFEA), said that some IVF clinics are using intracytoplasmic sperm injection (ICSI) simply because it is easier than standard IVF, rather than because it is in the best interests of patients. "We believe it is being used far too widely because it is procedurally easy," Professor Jardine said. "The scientists who advocate it already know that a boy born through ICSI is likely to have a low sperm count. So it is a little bit worrying that it is being rolled out so widely." She recently warned on BBC Radio 4 that success rates for couples, who typically spend around £15,000 for three cycles of treatment, are "discouragingly low". ICSI was first introduced about 20 years ago, since when its use has become widespread. In 2011, more than half of the nearly 62,000 cycles of fertility treatment, involving just over 48,000 women in Britain, were done with ICSI, rather than letting the sperm penetrate the egg naturally. In many other countries – in North America and Europe for instance – the figure is even higher, with ICSI being used in as many as 90 to 95 per cent of IVF cycles. Yet some studies suggest that IVF children born from ICSI may be at higher risk of medical problems as they grow older, including male infertility. "We know that babies born from ICSI have increased risk of some problems later in life and infertility is one of them," said Allan Pacey, chairman of the British Fertility Society and an IVF specialist at Sheffield University. "For these reasons we should be prudent over the use of ICSI. So let's use ICSI when it's needed, and not as some kind of guarantee against fertilisation failure, which is how some clinics approach it." Professor Jardine, who steps down as chair of the HFEA in the new year, said she shares the concerns of some experts, who believe that many fertility clinics are opting to use ICSI simply because it is easier to achieve rapid fertilisation of an egg, rather than using it specifically as a treatment for male infertility. About half of the couples given ICSI have male-related fertility problems, while about 12 per cent have joint male and female factors, and 10 per cent have specifically female fertility problems. In 20 per cent of cases, ICSI is used for "unexplained" reasons, according to data gathered by the HFEA. One of the pioneers of ICSI, André Van Steirteghem of the Brussels Free University Centre for Reproductive Medicine, warned in 2010 that IVF clinics are routinely overusing the treatment despite the risk of long-term health problems in the children conceived by the technique. "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 are a few more problems with these children," Dr Van Steirteghem said. "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," said Dr Van Steirteghem. He advises the HFEA on new developments in fertility treatment. However, Professor Pacey said that Britain is one country that is probably not overusing ICSI overall: "As a country overall we've got it about right, because about half of the fertility problems are male related and half are female related, and there is a 50:50 split between ICSI and conventional IVF." "But there may be some individual clinics that are doing it more than they should. They are frightened of fertilisation failing. The HFEA should be focusing on these individual clinics with high ICSI levels," he added. Article: 4th November 2013 www.independent.co.uk

Male fertility treatment increases mental impairment and autism in children

Researchers have reported that children born following an IVF treatments for male infertility are 51% more at risk of developing intellectual impairments than those born by normal conception. Around half of the 48,000 IVF treatments carried out annually in Britain use this form of fertility treatment, known as intra-cytoplasmic sperm injection (ICSI). It is used where the men are deemed to be almost completely infertile and involves injecting the sperm directly into their partner’s egg. However, the technique is already considered to be controversial as it has been linked to an increased risk of birth defects. The study also found that in the most severe cases of male infertility, where men require surgery as part of the treatment, children were more than four times more likely to develop autism. However, the number of men who undergo this are small so the numbers of actual cases are extremely low. Dr Avi Reichenberg, from the Institute of Psychiatry at King's College London, who led the study, said: "About 50 per cent of IVF treatments use ICSI in the UK. “Our study shows that these treatments developed to manage male infertility are associated with an increased risk for developmental disorders in the offspring. “Whilst intellectual disability or autism remain a rare outcome for IVF, being aware of the increased risk associated with certain types of IVF means offspring at risk can be identified and potentially monitored for developmental disorders.” The study, which is published in the Journal of the American Medical Association, analysed data from more than 2.5 million births in Sweden, of which 30,959 were conceived using IVF treatment. They found that among those children who were conceived naturally, the risk of mental disability, defined by an IQ below 70 and an inability to perform every day skills such as learning, communication or social relationships, was just 62 out of every 100,000 births. Standard IVF increased the risk by around 18 per cent, but when children who had been born as twins or triplets were taken into account this increase disappeared. This is because even naturally conceived twins and triplets have an increased risk of developing a mental disability in later life, however, mothers who undergo IVF are more likely to give birth to multiple children in one pregancy. However, among those children conceived following IVF with ICSI, the risk increased by 51 per cent compared to natural conception, with 93 out of every 100,000 developing a mental disability. This remained high even after taking twins into account. In the UK, this would be equivalent to 22 of the 24,000 births achieved using IVF with ICSI would have an intellectual disability. A subset of the patients who had received IVF with ICSI saw the men need surgery to retrieve their sperm. This increased the risk of the children developing severe autism by 4.6 times standard IVF. However, the number of patients who have to undergo surgical ICSI are extremely low and when the researchers looked at children who had been born alone the risk disappeared. It is unclear why the risk is so much greater in multiple births using this technique than in the general population. The researchers claim this presents a strong argument for an increase in the use of IVF techniques that transfer just a single fertilised egg into the mother as this would help to reduce the chance of twins or triplets being born. Dr Karl-Gösta Nygren, co-author of the paper from the department of medical epidemiology at Karolinska Institutet, said: “I find these results reassuring as the risk is very small. The risk of birth defects is much higher. “Some of these risks are even preventable, so using single egg transfer could prevent multiple births for example. “There is a strong argument for extending the use of single egg transfer to diminish these risks.” He added that it is likely the increased risk created by the use of ICSI is due to defects carried in the sperm rather from the procedure itself. The use of ICSI has attracted criticism in recent years as it can cause sperm that contain genetic defects to be selected and injected into an egg when they would not normally survive to make the arduous journey to the egg. It has also caused ethicists to question whether such techniques should be used as it circumvents one of the ways nature has evolved to prevent poor quality genes from being passed on. A recent found, for example, that in 10 per cent of births using ICSI, the baby had a birth defect, compared to less than six per cent in natural births. Dr Alan Pacey, a fertility expert at the university of Sheffield and chairman of the British Fertility Society, said: “The main message of the paper is a positive one, suggesting that any risk of these disorders is very low in comparison to children conceived naturally. “It does highlight the importance of preferentially using standard IVF rather than ICSI.” Between one and two per cent of the children born in the UK are conceived through IVF. Sally Goddard Blythe, director of the Institute for Neuro-Physiological Psychology in Chester, which helps children with learning disabilities, said that she has noticed an increase in the number of children she was working with who had been conceived through IVF. She said: “Over the past 20 years, we are seeing an increase in the percentage of children at an older age who were conceived as a result of IVF. “We have 75 to 80 new families coming in to see us a year. The incidence of IVF in their developmental history in the past two years is 10 per cent while 20 years ago “Obviously there are more children being conceived through IVF but these figures still seem higher than they would normally be without it being an additional risk factor.” “More attention needs to be paid to this.” Article: 4th July 2013 www.telegraph.co.uk