France debates ethics of sperm injection techniques
BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7010.896 (Published 07 October 1995) Cite this as: BMJ 1995;311:896
The rapid expansion in France of the technique of intracytoplasmic sperm injection for infertility, in which sperm are injected into the cytoplasm of ova, has stirred up a controversy over the safety and the ethical propriety of the technique. There are particular concerns over a newer technique involving the injection of spermatids, the round, unflagellated precursors of sperm, which are found in the testicles and semen of many infertile men.
Some doctors and geneticists fear that intracytoplasmic sperm injection may lead to anomalies in the sex chromosomes of the fetuses and perhaps to the transmission—for the first time in history—of sterility from generation to generation.
In Belgium, where the method was launched in 1992 by Professor Andre van Steirteghem of the Universite Libre in Brussels, about 900 children have been born as a result. In France, up to May this year, 23 laboratories had attempted intracytoplasmic sperm injection on about 13500 ova. They obtained 6065 embryos, of which 4030 were implanted, with pregnancies resulting in 21% of cases. The number of hospitals and clinics practising the technique is known to have increased in recent months, and by now the technique may be used by a most of the 100 or so French teams practising in vitro fertilisation.
This rapid spread of the technique has happened in spite of the recommendation last year by Professor Jean-Francois Mattei, one of the authors of the French bioethics legislation, that only two or three teams be authorised to practise it. A number of specialists are concerned about this escalation, particularly since the publication in the Lancet last month (346; 773) of a letter by Belgian and Dutch specialists who reported five anomalies of sex chromosomes in 15 children born after intracytoplasmic sperm injection.
A number of doctors and geneticists believe that the technique (which some have called “the rape of the ovum”) should not become routine before it has been proved to be harmless to the fetus.
A major opponent is Professor Axel Kahn, director of the Genetics and Molecular Pathology Research Laboratory at the Cochin Hospital's Institute of Molecular Genetics in Paris. He says that the technique presents a serious ethical problem because the medical condition of infertile couples, who can be treated with donor sperm, is not sufficiently urgent to justify the use of a still experimental technique.
He and others argue that the technique may be dangerous because the use of sperm selected at random bypasses the competition between sperm that takes place in natural fertilisation and conventional in vitro fertilisation and that it may transmit sterility and perhaps even malformations if paternal sterility results from chromosomal accidents.
The newer technique of injecting spermatids, reported in August by Dr Jacques Testart, director of the Gamete Maturity and Fertilisation Laboratory in Paris, is even more controversial. Dr Testart, one of France's best known fertility specialists, has injected unflagellated spermatids. This technique led to the birth of a baby in June and another last month.
