Our expert says:
The indications for ICSI are very different from that of IVF in a laboratory setting. ICSI is reserved for extremely severe male factor problems. In such cases, should the sperm be analysed genetically, one will find a higher rate of DNA damage already existent in the sperm and therefore it is doubtful whether the poorer embryo qualities and overall lower implantation rates are related to the procedure perse.
ICSI is not a relatively new procedure and there have been fairly reliable publications of sufficient magnitude to allay any fears of increased developmental or physical problems. Where some reports have suggested behavioural anomalies, these reports have been anecdotal and not of a sufficiently convincing nature. However one cannot simply refute or disregard these possibilities and as you have mentioned in point three there is a positive correlation in the transmission of y-antigen defects to the offspring, meaning that the male offspring may suffer the same feit in terms of sperm quality as his father.
However it is also important to note that not the strongest, but the morphologically or shape wise most normal sperm are selected and these have been shown to also be the genetically most normal sperm and hence ICSI certainly would improve the outcome in general for a particular sperm composition.
The risk of ectopic is no greater than that of IVF. The choice between IVF and ICSI is clearly one of sperm quality and should the wrong decision be taken then one runs the definite risk of total failure of fertilisation in the laboratory and hence a completely failed cycle.
Also it is important that with new modern genetic testing available embryos can be pre-tested by means of PGD, before transferring them to the uterus.
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