It appears infertility is becoming more of a male problem, according to a recent report released at the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE).1 The report was released by members of the ESHRE committee, which monitors assisted reproduction practices in Europe.
It has been estimated that men and women equally share causes of infertility; about one-third of causes can be attributed to men and likewise for women. The final third is attributed to unknown factors.2
ICSI Procedures Climbing: Report
However, according to the ESHRE report, the numbers of cycles using intracytoplasmic sperm injection (ICSI) are steadily increasing, suggesting that male-factor infertility is also on the rise. The report's findings mirror those of the latest monitoring report released by ESHRE's counterpart association, the American Society for Reproductive Medicine, that also showed ICSI procedures on the rise in the United States.3
ICSI is a laboratory procedure that involves the microinjection of a single sperm directly into the cytoplasm of a mature egg using a glass needle. The sperm used is typically the healthiest from a sample collected. Nonetheless, as long as the egg is viable, more than half of these procedures end in a successful fertilization, even in cases in which sperm quality is poor, according to ESHRE. This method is used in cases in which a couple's infertility is caused by a male factor, such as abnormalities in the number, quality, or function of the sperm.4
ICSI Overtakes IVF in Europe
The report says the numbers of ICSI procedures overtook conventional in vitro fertilization (IVF) cycles performed in 2002—the year studied—as the most commonly used assisted reproductive technology in Europe. There were over 122,000 ICSI cycles performed that year compared to nearly 113,000 IVF procedures performed, the report states. During the time that the ESHRE committee has been producing its report, an increasing trend in the number of ICSI procedures performed has been noted: in 1997, the figure stood at about 44%. In 2002, it had jumped to 52% of all procedures performed.
By comparison, according to the ASRM, ISCI accounted for about 42% of all IVF procedures performed in 1999 in the United States, compared to nearly 47% of IVF techniques performed the following year—the latest year for which statistics are available.
"We do not really know why ICSI has become more prevalent," said Anders Nyboe Andersen, MD, director of the fertility clinic at Rigshospitalet at Copenhagen University Hospital in Denmark and coordinator of the ESHRE IVF Monitoring Committee. "There are probably many reasons."
One of those might be that the causes of infertility are "shifting", Nyboe Andersen speculates. Since the risk of AIDS has become a more prominent topic in recent years, sexual protection has, likewise, become more common. Thus, the number of infertility cases caused by severe fallopian tube disorders has dropped, he predicts. Simultaneously, male infertility cases may have risen during the same time period.
"Maybe environmental factors are playing an increasing role as the planet becomes more polluted and factors that disrupt the endocrine system enter the food chain," Nyboe Andersen said.
Another possibility is that more and more doctors are using ICSI as fears about its safety and effects on the health of infants begin to wane, he added.
Limiting Multiple Birth Risk
The committee also issued statistics on the quality and effectiveness of assisted reproductive technologies (ART) in Europe. From 1997 to 2002, there has been a minor reduction in the number of twin births, as an increasing number of physicians choose to transfer only one embryo to the uterus in an IVF cycle to reduce the risk of a multiple birth. Similarly, triplet births have declined using IVF and ICSI from about three and-a-half percent to 1.3% during that same period.
The report notes that up to two embryos were transferred in 70% of the cycles studied. The pregnancy rate, meanwhile, has remained the same or improved in some cases, the report noted.
Single embryo transfer has been in widespread practice primarily in Scandinavia and is about to be implemented in Denmark, Nyboe Andersen told Priority Healthcare. "Additionally, elective single embryo transfer is practiced a lot in Belgium, where 6 free-of-charge IVF cycles are offered, but with certain conditions," he explained, "like the use of single embryo transfer to keep the cost low."
"This is good news for mothers and babies because multiple births are dangerous for both, and can cause congenital problems in the offspring," added committee chairman Karl Nygren, MD, PhD. Nygren is an associate professor of Obstetrics and Gynecology at Sofiahemmet Hospital in Stockholm, Sweden.
'Dramatic' Statistics
Single embryo transfer protocols have become even more restrictive in Sweden. In 2003, the country banned the practice of transferring more than two embryos in ART cycles. But it has not negatively affected pregnancy success, Nygren pointed out. "The 2004 data show that 70% of all Swedish cycles were single embryo transfers, but the pregnancy rate per embryo transfer remained constant at around 30%, while the number of twin births has plummeted to just 5%, and there were no triplet deliveries at all," he said.
"These are really dramatic figures that show that single embryo transfer should be the first choice for young couples seeking fertility treatment," Nygren added.
1. 21st Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE). 2005 Jun 19-22. Copenhagen, Denmark.
2. American Society for Reproductive Medicine (ASRM). Frequently Asked Questions About Infertility. Available at: http://www.asrm.org/Patients/faqs.html#Q1:. Accessed June 28, 2005.
3. Society for Reproductive Technology. American Society for Reproductive Medicine. Assisted reproductive technology in the United States: 2000 results from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. Fertil Steril 2004 May;81(5):1207-20.
4. American Society for Reproductive Medicine (ASRM). Patient's Fact Sheet: Intracytoplasmic Sperm Injection (ICSI). Available at: http://www.asrm.org/Patients/FactSheets/ICSI-Fact.pdf. Accessed June 28, 2005.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
