Intracytoplasmic sperm injectionBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7068.1334b (Published 23 November 1996) Cite this as: BMJ 1996;313:1334
Karyotyping should be done before treatment
- William Buckett,
- Ian Aird,
- Murray Luckas,
- Charles Kingsland,
- Iwan Lewis-Jones,
- Peter Howard
- Research fellow Lecturer Research fellow Consultant in obstetrics and gynaecology Consultant andrologist Consultant clinical geneticist Reproductive Medicine Unit, Liverpool Women's Hospital, Liverpool L8 7SS
EDITOR,—Concern has been expressed about the genetic consequences of intracytoplasmic sperm injection for the treatment of male factor infertility.1 2 We wish to report the early results of our chromosomal screening programme for this procedure. The programme was introduced after earlier reports of increased chromosomal abnormalities in pregnancies resulting from treatment with intracytoplasmic sperm injection (M Bonduelle et al, proceedings of the 4th international workshop on assisted fertilisation by intracytoplasmic injection of epididymal and testicular sperm, European Society for Human Reproduction and Embryology, Brussels, 1994).3
To date, 33 patients with varying degrees of oligospermia and asthenospermia have been screened with karyotyping of peripheral blood cells; four abnormal karyotypes have been detected. Two of the abnormal karyotypes were Klinefelter mosaics (47XXY/46XY); in one case four of the 28 cells examined exhibited XXY, and in the other case one of the 20 cells examined exhibited XXY. The two other karyotypic abnormalities were pericentric inversions, one involving autosomes (46, XY, inv(3)(p21q13.2)) and the other involving the Y chromosome (46X,inv(Y)(p11.3q11.2)).
These initial results suggest higher rates of chromosomal abnormality than have been reported previously4 and do not take into consideration more subtle abnormalities which may be confined to the germ cells. This increased rate is probably attributable to the fact that we screen only patients with more severe abnormalities of sperm function.
On the basis of these early results, and in the light of current concerns, we would recommend that chromosomal screening should be mandatory for all patients before treatment with intracytoplasmic sperm injection, to reduce the risk of chromosomally abnormal fetuses.