Shifting Blame
Figures released at the 21st annual conference of the European Society of Human Reproduction and Embryology suggest that infertility may have turned tail, as it now appears to be affecting more men than women. Up to now, the balance was about equal, with 40% of infertility cases attributed to women and just as many attributed to men. The 20% balance is due to problems where infertility occurs in both halves of a couple.
But the ESHRE report, produced by a committee responsible for monitoring assisted reproduction in Europe, shows that intracytoplasmic sperm injection (ICSI) has overtaken IVF as the most common assisted reproductive technique in Europe. In the year 2002, for example, there were over 122,000 ICSI attempts but only 113,000 IVF cycles. The committee has seen a steady rise in the number of ICSI cycles performed. Whereas in 1997, the ratio of ICSI to IVF cycles stood at 43.7, by 2002, it had risen to 52%.
Shifting Causes
A coordinator of the ESHRE IVF monitoring committee, Dr. Anders Nyboe Andersen, of the Copenhagen University Hospital, Denmark, explained that the committee doesn't really know the reason ICSI has become more prevalent but suggests there may be many reasons, among these shifting causes of infertility. Fewer women are having scarring and other tubal problems, because the risk of AIDS has led to better sexual protection against all STDs in the last 20 years. On the other hand, it seems that more men are having fertility issues. Some experts suggest that pollution and other environmental issues have led to a general decline in sperm quality across the board.
ICSI has only been in use a short time, with the first ICSI baby delivered in 1992. But there is a world of difference between IVF and ICSI. IVF requires over a half million sperm for a chance at fertilization, while ICSI needs only one sperm per egg.
Sperm Quality
Furthermore, sperm quality doesn't seem to be much of an issue, since half of all eggs fertilize with no problem, as long as the sperm is alive. "It is also possible that as ICSI techniques have improved, patients and doctors are voting with their feet and using it in ever increasing numbers, despite any residual fears about its safety and the health of ICSI babies," said Dr Nyboe Andersen.
There does seem to be much truth in this statement, since the figures on European assisted reproductive technology are getting better and better. Professor Karl Nygren, Associate Professor of Obstetrics and Gynaecology at Sofiahemmet Hospital in Stockholm, Sweden and a chairman of the ESHRE committee said, "During the six year period from 1997 to 2002 there has been a minor decline in twin birth rates, and triplet birth rates have fallen from 3.6% to 1.3% after IVF and ICSI…This is good news for mothers and babies, because multiple births are dangerous for both and can cause congenital problems in the offspring."
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