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Questions about use of IVF procedure for male infertility

By Mary Elizabeth Dallas

Although use of an IVF treatment for male infertility, known as intracytoplasmic sperm injection (ICSI), has doubled in the past decade, the procedure is not always associated with better outcomes, according to a new study from the U.S. Centers for Disease Control and Prevention.

During ICSI, a single sperm is injected directly into an egg. The procedure, which was introduced in 1992, made it possible for many infertile men to father children.

"In the pre-ICSI days, couples with severe male infertility would frequently have to resort to donor insemination, thus eliminating the possibility of the man to be the genetic parent," explained one expert, Dr. Avner Hershlag, chief of the Center for Human Reproduction at North Shore University Hospital in Manhasset, N.Y.

"There are now millions of children and adults whose fathers had deficient sperm, and it is because of ICSI that they have been created," said Hershlag, who was not involved in the new study.

However, the CDC study authors said that unlike conventional in-vitro fertilization (IVF), ICSI is much more expensive.

In conducting the study, the team of researchers, led by the CDC's Sheree Boulet, analyzed almost 1.4 million fresh IVF cycles reported to the U.S. National Assisted Reproductive Technology Surveillance System between 1996 and 2012.

Of these IVF cycles, 65 percent involved ICSI and about 36 percent involved male infertility. Among fresh IVF cycles, ICSI use in the United States increased from 36 percent in 1996 to 76 percent in 2012, the researchers reported.

In cases involving men with male infertility, ICSI use jumped from about 76 percent in 1996 to more than 93 percent by 2012. Among men who were not infertile, ICSI use rose from just over 15 percent to about 67 percent.

Between 2008 and 2012, about 36 percent of fresh IVF cycles involved male infertility. The researchers noted that when male infertility was not an issue, using ICSI in an IVF procedure was tied to a slight drop in implantation, pregnancy, live birth and low birth weight rates, compared to using conventional IVF.

Hershlag said that the finding "may point to overuse of the ICSI procedure in some couples." But he also said that it is not always easy to determine "fertilization potential" in men, many of whom may have normal results on sperm tests.

"Until IVF is performed, for patients who have never conceived before, there is no absolute certainty that the sperm will fertilize an egg," Hershlag said.

Dr. Alan Copperman is director of the division of reproductive endocrinology and infertility at the Mount Sinai Hospital in New York City. He said that "while ICSI was originally performed for severe male factor infertility, there are now many indications for its use, and it is now used in three-quarters of the IVF cycles now performed in the United States."

According to Copperman, technologies have advanced so that doctors can now pinpoint the healthiest egg and sperm. So, "rather than placing tens of thousands of sperm on top of each egg, we choose a single sperm and perform ICSI."

Egg-freezing technologies are also boosting the use of ICSI, he added. "We are seeing more women electively freezing their eggs, and ICSI must be used instead of conventional insemination to achieve fertilization when the eggs are thawed and ready to be used," Copperman explained.

The study was published Jan. 20 in the Journal of the American Medical Association.
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Women with advanced age are rejected to cryopreserve their eggs in Mainland China.

In 2014, Apple and Facebook, US, offered to cover their female labor's for freezing eggs to help them focus on their career performances without worrying about the fertility issues.

After the news released, many female labors in Shanghai were stirred up. Lots of fertility centers at the local hospitals received the inquiries about "fertility preservation at the egg banks." quite often. However, the local fertility specialists reminded these excited females that the Chinese government still does not allow doing egg cryopreservation to the healthy women yet.

" Dr.X, would I freeze my eggs?" Miss Wang was already 32 years, and she was working for an art gallery. She visited an outpatient department of fertility center to consult about egg cryopreservation, since she had no romantic relationships in her busy life. In addition, she really hoped that she could focus on both art creation and finding her Mr. right in the future. With no clinical reports to prove the necessity of egg freezing, she was rejected by the fertility specialist immediately.

According to the Prof. Sun, an expert in the reproductive realm, the cases consulting for egg freezing were mainly females with age of 30 to 35 years, working in the big cities. They were well-educated and have ploughed on with the busy works to accumulate remarkable property for several years. Moreover, they were still waiting for the person to realize the dream of becoming a wife and a mother. The technique of egg freezing seems very promising and attractive.

"Out center only provides this service to two kinds of female cases. One is those who have oncologic issues and must cryopreserve their fertility before getting treatments. Another one is the IVF cases whose husbands could not provide their sperm samples on the oocyte retrieval date." Prof. Sun said.

What do we need to know,

a. Oocyte cryopreservation (egg freezing) is the former step of conventional IVF program, from controlled ovarian stimulation to oocyte vitrification.

b. Since the social structure changes dramatically, more female labors face the dilemma of focusing on their career lives or personal lives, so more countries have released this service to the women with this necessity, namely the cases with social-oocyte-freezing (SOF).

c. Taiwanese Reproductive Act does allow the SOF cases to do egg freezing at the local fertility centers.

➤Learn more about Egg Freezing procedure in Taiwan.
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