A recent study published in the journal of human reproduction revealed that babies conceived through intracytoplasmic sperm injection (ICSI), one method of fertility assistance may show inferiority in sperm count and quality compared to those conceived naturally.

There is however a lack of clear causation and definitive evidence thus far as this is the first ever analysis of young men conceived through this procedure since the early 1990s.

Assisted fertility on the rise globally

Thousands of in vitro fertilisation (IVF) babies have been born all over the world since the first in 1978. Preliminary data from the Singaporean Health Ministry (MOH) shows that 6,044 assisted reproduction cycles were done in Singapore last year, making it the second year that these highly demanded procedures has crossed the 6,000 mark. The first IVF baby was conceived 38 years ago in Malaysia and has since also become an obstetrical boom for those of the more affluent status and in need.

"The increase in the number of couples seeking treatment may be due to improving pregnancy rates, better awareness and increased affordability," said Dr Sadhana Nadarajah, director of the KKIVF Centre at KK Women's and Children's Hospital.

54 men who were conceived by what is commonly known as intracytoplasmic sperm injection (ICSI), a technique developed in the 1990s to treat cases of infertility associated with problems concerning a man’s sperm were being studied.

However, a major concern about ICSI, which is one of the most common methods of IVF in treating male infertility is that it may cause men conceived this way to inherit such defects from their fathers. This speculation come from professor Van Steirteghemat and colleagues from the Centre for Reproductive Medicine at the Vrije Universiteit Brussel (VUB) in Belgium who led the study on 54 men born through ICSI between 1992 and 1996.

A link between the procedure itself and production of sperm with similar defects to donor parent was made.

No room for generalisation

However, the study demonstrates that specific semen traits of ICSI fathers do not predict the same values in their sons. While genetic factors do contribute to male infertility, other comparative arms such as age, existing medical conditions and nature need to be taken into account.

Professor Simon Fishel, managing director of Care Fertility in the UK, a network of private fertility clinics, said, "This small study is useful but not unexpected in that we have been counselling couples since first using sperm micro injection 25 years ago that, due to genetic reasons, 'ICSI may beget ICSI'.”

We may still discover that these men are able to conceive naturally as merely having low semen parameters is not conclusive enough evidence for the requirement of ICSI or IVF technologies as a whole. More follow-up studies from this first of its kind one will be required to ascertain meaningful data and implications.

Multiple births from IVF wrongly perceived as a gift

However, while IVF remains as a prayer answered for most infertile couples dreaming of a family, there are other factors and numbers to consider in the quest to have a baby. Naturally, the increased use of assisted reproduction technologies has contributed to an increase in multiple births during the same pregnancy – and while the idea of having two babies seem appealing and tugs at your heart strings, the reality of triplets, quadruplets or even quintuplets can be daunting, to say the least.

Most fertiliity specialists implant three to five embryos to maximise the potential of success. Some doctors have been known to embark on even riskier behaviour in order to ensure client satisfaction. As a result, 45% of IVF babies worldwide are high-order pregnancies which represent numbers higher than two.

Multiple pregnancies carry with them associated risks including a higher incidence of neonatal mortality, birth defects, premature delivery and low birth weight. Mothers are also more prone in developing pregnancy-related complications like spontaneous abortions, hypertension, gestational diabetes, pre-eclampsia, placental abnormalities, and the list goes on.

In August, the American College of Obstetricians and Gynaecologists stated that “electively” transferring just a single embryo each time can also achieve high pregnancy rates with less risk posed to babies and mothers and “a drastic reduction in multi-foetal pregnancy”.

Patients, especially those desperately trying to conceive for years, can easily be overwhelmed by the profit-making practices in fertility treatments and unable to distinguish between good medical practices and a marketing strategy.

Thus, it really boils down to the integrity of these doctors to educate patients into realising that multiple pregnancies are an undesirable outcome that can be completely avoided if both parties agree that single embryo transfer is the right thing to choose. MIMS

Read more:
What patients may not know about fertility treatments in Singapore
Negligence by Singaporean fertility centre leads to mix-up during IVF treatment
Advance in assistive reproductive technology set to greatly improve conception rates
Only the best: New technique allows for better selection of embryos in IVF