Abstract
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 has revolutionized the treatment of male infertility (1) and has allowed couples whose only prior options were donor insemination to achieve pregnancies or adoption. Although in vitro fertilization (IVF) and related procedures have been used in the past for the treatment of male infertility, most assisted reproductive technology centers are using ICSI as the primary treatment for male infertility. Table 1 lists the cause of male factor infertility. Only a small minority of such patients are amenable to specific hormonal or pharmacologic therapy. Of these, the most probable candidates are the 1–2% of men with male infertility secondary to hypothalamic-pituitary (gonadotropin) insufficiency. These patients respond well to gonadotropin or GnRH therapy. Specific medical treatment is not available for most patients with testicular or idiopathic causes of male infertility. These patients are candidates for assisted reproductive technologies using oocytes from their spouses or partners. This article reviews the ICSI procedure, its indications, and techniques used to retrieve sperm and the risks and concerns that have been raised in regard to its safety, including the genetic risks to the fetus.
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