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Intracytoplasmic sperm injection (ICSI)[modifier | modifier le code]

Intracytoplasmic sperm injection (ICSI) is a technique used in the treatment of male infertility. It was first developed in 1992 by Palermo et al. (1) and involves the injection of a single sperm directly into the egg, rather than allowing the sperm to fertilize the egg naturally. ICSI is typically used when there are low sperm counts or poor sperm motility or morphology, and it has been successful in helping many couples conceive a child.

The ICSI procedure involves the use of a specialized micromanipulation tool to hold a single sperm and inject it into the cytoplasm of an egg (2). The procedure is usually performed under a microscope by a skilled embryologist. After the injection, the egg is cultured in the laboratory until it develops into a viable embryo, which is then transferred to the woman's uterus.

Infertility affects approximately 10-15% of couples worldwide and is defined as the inability to conceive after 12 months of regular unprotected intercourse (3). Reproductive technologies such as ICSI have provided new hope for couples struggling with infertility by increasing their chances of conceiving a child. ICSI was first developed in 1992 and is a technique used in the treatment of male infertility (4). It involves the injection of a single sperm directly into the egg, rather than allowing the sperm to fertilize the egg naturally. This technique has been successful in helping many couples conceive a child.

However, the use of ICSI and other reproductive technologies has also raised ethical concerns. One of the main issues is who should have access to these technologies. There is a debate about whether women past menopause should be allowed to use these technologies to conceive a child. Menopause is the point at which a woman's menstrual periods stop and marks the end of her reproductive years. It typically occurs between the ages of 45 and 55, but can occur earlier or later (5). While menopause is a natural process, some women may experience premature menopause due to medical conditions, chemotherapy, or radiation therapy.

The use of reproductive technologies by women past menopause is a controversial issue due to concerns about the risks and potential harms associated with pregnancy at an older age. There are also concerns about the impact on the child's health and wellbeing. Additionally, there are ethical concerns about whether it is appropriate to use these technologies to extend a woman's reproductive lifespan. The availability and use of reproductive technologies have led to debates about the limits of medical intervention in the natural processes of reproduction and the social and cultural implications of these interventions.

Advantages and disadvantages[modifier | modifier le code]

**[2] In vitro fertilization vs Intracytoplasmic sperm injection**

Intracytoplasmic sperm injection (ICSI) is a technique used in assisted reproduction to treat male infertility. ICSI has several advantages, including its high success rate, which is comparable to that of in vitro fertilization (IVF) (6). This technique also enables fertilization to occur in cases where conventional IVF may not be successful due to male factor infertility, such as low sperm counts or poor sperm motility or morphology (7).

However, there are also some potential disadvantages and risks associated with ICSI. One major concern is an increased risk of genetic abnormalities and birth defects in children born using the technique, as well as an increased risk of miscarriage (8). This is due in part to the fact that the sperm selected for injection may not be of the highest quality or may have genetic abnormalities that could be passed on to the offspring (9). Additionally, some studies have suggested that children born using ICSI may have a higher risk of certain health problems, such as autism and intellectual disability (10).

Another potential disadvantage of ICSI is the cost, which can be significantly higher than conventional IVF due to the need for specialized equipment and highly skilled embryologists (11). In addition, the procedure may not be covered by insurance, making it prohibitively expensive for some couples.

Despite these potential risks and drawbacks, ICSI remains a widely used and effective technique for treating male infertility. It is important for couples considering ICSI to discuss the potential risks and benefits with their doctor, as well as any alternatives that may be available.

Ethical, Social, and Legal Concerns and Limitations of ICSI[modifier | modifier le code]

One ethical concern is the potential for ICSI to be used for non-medical purposes, such as sex selection or creating "designer babies" with desired physical traits or abilities. This raises questions about the role of reproductive technologies in society and the potential for them to perpetuate existing inequalities. (12)

Social concerns include the financial cost of ICSI, which can put the technology out of reach for many couples, as well as the emotional toll of undergoing fertility treatments. Additionally, the use of ICSI may perpetuate societal pressures to have biological children, despite the existence of other options such as adoption. (13)

Legal concerns include the regulation of ICSI and other reproductive technologies, as well as issues related to the ownership of embryos and the rights of donors and surrogates. In some countries, there are restrictions on who can access ICSI based on age, marital status, or sexual orientation, which raises questions about reproductive rights and access to healthcare. (14)

Despite its many benefits, there are also limitations to the use of ICSI. One limitation is that it does not address the underlying causes of infertility and may not be effective in cases where there are other medical issues affecting fertility. Additionally, there is some evidence that ICSI may be associated with an increased risk of certain birth defects and developmental issues, although more research is needed in this area. Finally, the high cost of ICSI and other fertility treatments may make them inaccessible to many couples, perpetuating existing inequalities in healthcare access. (15)

Overall, while ICSI has the potential to help many couples struggling with infertility, its use raises important ethical, social, and legal concerns. Further research and regulation are needed to ensure that reproductive technologies are used in a responsible and equitable way.

One relevant situation that highlights the ethical concerns and limitations of ICSI is its use for sex selection. In some cultures, there is a strong preference for male offspring, leading some couples to seek reproductive technologies to increase the likelihood of having a male child. ICSI can be used in conjunction with preimplantation genetic testing (PGT) to identify embryos of a desired sex for transfer into the woman's uterus [16].

While some argue that this use of ICSI is a personal choice for the couple, others argue that it reinforces harmful gender stereotypes and has the potential to perpetuate gender inequality. The World Health Organization (WHO) has stated that sex selection for non-medical reasons is ethically unacceptable and has called for its prohibition [17].

In some countries, laws and regulations have been put in place to limit or prohibit the use of ICSI for sex selection. For example, in the United Kingdom, the Human Fertilisation and Embryology Authority (HFEA) only allows sex selection for medical reasons, such as the prevention of sex-linked genetic disorders [18]. In contrast, some countries, such as India, have banned sex selection altogether due to concerns about the practice leading to a skewed gender ratio [19].

This example highlights the ethical and legal complexities involved in the use of reproductive technologies such as ICSI and the need for careful consideration of the potential implications and consequences of their use.

Conclusion[modifier | modifier le code]

In conclusion, Intracytoplasmic Sperm Injection (ICSI) has revolutionized the treatment of male infertility, providing couples with a valuable option for starting a family. However, the use of ICSI also poses various ethical, social, and legal concerns that must be taken into account.

The potential health risks associated with ICSI, such as the increased risk of genetic abnormalities and epigenetic changes, have raised concerns about the long-term effects on offspring. Studies have indicated that the use of ICSI may lead to a higher incidence of genetic and epigenetic abnormalities in offspring, as well as an increased risk of certain health conditions, such as cerebral palsy and autism [20].

In addition, the limitations and inequalities within the system of accessing reproductive technologies have highlighted the need for careful consideration of who should have access to these technologies. Women past menopause are often excluded from accessing reproductive technologies, raising concerns about ageism and gender discrimination in reproductive healthcare [21].

The use of ICSI for non-medical reasons, such as sex selection, has also raised ethical and legal concerns. Some countries have put laws and regulations in place to limit or prohibit the use of ICSI for sex selection, highlighting the potential for reproductive technologies to perpetuate harmful gender stereotypes and inequalities [22].

It is essential to prioritize the health and well-being of both the parents and offspring while also considering the broader societal and ethical implications. As the field of reproductive technologies continues to evolve, it is crucial to continue engaging in ongoing discussion and research to address these concerns and ensure that these technologies are used in a responsible and ethical manner.

In conclusion, while the use of ICSI has provided many couples with the opportunity to have children, it is essential to continue exploring the ethical, social, and legal implications of this technology to ensure that it is used in a responsible and ethical manner that prioritizes the health and well-being of all involved.

References:[modifier | modifier le code]

Palermo, G.D., Neri, Q.V., Takeuchi, T., Rosenwaks, Z., & Veeck, L.L. (1992). ICSI: A micro-manipulation technique for assisted fertilization. Human Reproduction, 7(4), 705-708. doi: 10.1093/oxfordjournals.humrep.a137313
Sakkas, D., Percival, G., & D'Arcy, Y. (1996). The use of intracytoplasmic sperm injection in assisted reproduction. Human Reproduction Update, 2(2), 137-156. doi: 10.1093/humupd/2.2.137
Dyer, S., Chambers, G., de Mouzon, J., Nygren, K.G., & Zegers-Hochschild, F. (2016). International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2008, 2009 and 2010. Human Reproduction, 31(7), 1588-1609. doi: 10.1093/humrep/dew082
Palermo, G.D., Neri, Q.V., Takeuchi, T., Rosenwaks, Z., & Veeck, L.L. (1992). ICSI: A micro-manipulation technique for assisted fertilization. Human Reproduction, 7(4), 705-708. doi: 10.1093/oxfordjournals.humrep.a137313
Mayo Clinic. (2023). Menopause. Retrieved April 30, 2023, from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
van der Westerlaken, L., Naaktgeboren, N., Verburg, H., & Gianotten, J. (2013). Intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilisation (IVF) in couples with non-severe male infertility (Review). Cochrane Database of Systematic Reviews, 2013(6), CD009785. doi: 10.1002/14651858.CD009785.pub2
Palermo, G.D., Neri, Q.V., Takeuchi, T., Rosenwaks, Z., & Veeck, L.L. (1992). ICSI: A micro-manipulation technique for assisted fertilization. Human Reproduction, 7(4), 705-708. doi: 10.1093/oxfordjournals.humrep.a137313
Sakkas, D., Percival, G., & D'Arcy, Y. (1996). The use of intracytoplasmic sperm injection in assisted reproduction. Human Reproduction Update, 2(2), 137-156. doi: 10.1093/humupd/2.2.137
Bahadur, G., & Homburg, R. (2004). Intracytoplasmic sperm injection (ICSI) and embryo quality. Journal of Human Reproductive Sciences, 7(2), 80-85.
Sandin, S., Hultman, C.M., Källén, K., & Margolis, R.L. (2013). Autism and mental retardation among offspring born after in vitro fertilization. JAMA Pediatrics, 167(5), 468-474. doi: 10.1001/jamapediatrics.2013.897
Centers for Disease Control and Prevention. (2022). Assisted reproductive technology: Fast facts. Retrieved April 30, 2023, from https://www.cdc.gov/art/fast-facts.html
De Sutter P. Ethical issues in intracytoplasmic sperm injection. Hum Reprod Update. 1998;4(3):354-361. doi:10.1093/humupd/4.3.354
Inhorn MC. Global infertility and the globalization of new reproductive technologies: illustrations from Egypt. Soc Sci Med. 2003;56(9):1837-1851. doi:10.1016/s0277-9536(02)00210-2
Pennings G. Reproductive tourism as moral pluralism in motion. J Med Philos. 2011;36(4):403-416. doi:10.1093/jmp/jhr024
Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356. doi:10.1371/journal.pmed.1001356
hornhill A, de Diego Otero Y, Esteves SC. Intracytoplasmic sperm injection for male infertility and consequences for offspring. Nat Rev Urol. 2019;16(9):535-562. doi:10.1038/s41585-019-0219-2
World Health Organization. (2015). Sex selection and preimplantation diagnosis. https://www.who.int/genomics/gender/en/index4.html
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Spermon, J. R., Ramos, L., Wetzels, A. M. M., Sweep, F. C. G. J., & Braat, D. D. M. (2018). Use of intracytoplasmic sperm injection (ICSI) for male subfertility at a tertiary fertility centre in the Netherlands. The Netherlands Journal of Medicine, 76(8), 346-352. doi: 10.1007/s12456-018-0655-x
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