Genetic risks of intracytoplasmic sperm injection in the treatment of male infertility: recommendations for genetic counseling and screening

Objective: To review the most clinically significant genetic disorders associated with severe oligospermia and azoospermia in males, and to present recommendations for the genetic counseling and screening of infertile males and their partners before undertaking intracytoplasmic sperm injection (ICSI)-assisted reproduction. Design: The literature on genetic disorders associated with severe oligospermia and azoospermia was reviewed, and the most recent outcome data from surveys of ICSI-derived offspring are presented. Studies related to this topic were identified through MEDLINE. Result(s): Genetic disorders are not infrequent causes of severe oligospermia and azoospermia in males undergoing ICSI-assisted reproduction. The application of ICSI in the treatment of oligospermic or azoospermic males may result in the transmission or de novo introduction of genetic mutations or chromosomal abnormalities in their offspring. Genetic counseling and appropriate screening of couples with male infertility should be performed before their undertaking ICSI-assisted reproduction. Conclusions: An understanding of the genetic risks and possible consequences that are inherent when ICSI is used to assist fertilization in couples with male infertility is necessary for clinicians and their patients. (Fertil Steril(R) 1998;70:397-411. (C)1998 by American Society for Reproductive Medicine.).