Below we characterize the best data available on whether ICSI drives greater risks to the offspring, but before we drive in, a word about the quality of data we’re dealing with. Most studies here are:
Not Randomized Controlled: Patients who use ICSI are likely different (higher percentage of male factor infertility) those who did not. We don’t know if the difference in populations accounts for differences in outcomes.
Old: Most studies were published before 2005 and may not account for how ICSI is performed, or applied, today.
Do Not Compare Versus IVF: Many studies compare ICSI-born children versus naturally-conceived children. We think the more relevant question is how they compare versus other IVF-born children.
The data on the impact of ICSI, compared to IVF, on birth defects is mixed. One large population study from Australia showed a significantly increased risk of birth defects for populations using ICSI. However, multiple smaller studies showed no difference and two meta-analysis arrived at the same conclusion.
One Swedish study investigated the impact of ICSI vs. IVF on health complications at birth, ranging from cerebral hemorrhage to infant mortality. The study is large, spans multiple centers and is amongst the best we’ve seen on the subject. Investigators found no difference for any complication, except ICSI patients recorded statistically-significant lower rates of respiratory problems.
The data is more consistent when it comes to urogenital issues and sexual health issues faced by male offspring of ICSI: ICSI boys do appear to be at an increased risk of urogenital malformations requiring surgery, low testosterone levels, and possibly low sperm counts.
Again, this may be driven by the ICSI technique itself or the fact more ICSI patients suffered from male factor infertility to begin with.
We cover how male factor, non-male factor, poor responders, advanced maternal age, patients using PGS, and others respond to ICSI versus Conventional Insemination. We take a closer look at the specific metrics, like ICSI fertilization rate, needed to quantify a laboratory’s ability. We also delve into the data about how ICSI may increase the rate of birth defects and the urogenital impact to male offspring. We cite over 40 studies and use insights gleaned from interviews with embryologists, andrologists, reproductive urologists and reproductive endocrinologists.