Ethical issues in the use of assisted reproduction technologies in the treatment of male infertility

The development of intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility and bypasses many of the natural barriers to fertilization. However the recent demonstration that between 8-15% of men with severe oligozoospermic or azoospermia have deletions of the Y chromosome raises the possibility that ICSI will transmit this and other genetic disorders to the next generation. A further example is the use of sperm aspiration from the Testis with ICSI to manage the infertility due to congenital absence of the vas, due in many instances to mutations in the cystic fibrosis gene. The ability to recover small numbers of sperm for ICSI by testis biopsies from men with azoospermia due to severe hypospermatogenesis has also led to the possibility that the loss of testicular parenchyma may ultimately lead to androgen deficiency. This prospect is particularly pertinent irt men with high LH and low normal testosterone levels. More recent advances raise the possible use of spermatids or spermatocytes for intracytoplasmic sperm injection and pose difficulties of identifying the appropriate animal models to ensure safety considerations are met. Finally ethical dilemmas emerge from the treatment of females, with exposure to such ricks of ovarian hyperstimulation syndrome, for a male disorder.