Since the introduction of intracytoplasmic sperm injection (ICSI) as a treatment for severe male-factor infertility, the safety of the procedure has been questioned. Because of the invasive character of the ICSI technique, the risk of damaging the chromosomes during the injection procedure may be substantial. In addition, there may be an increased risk of the use of abnormal sperm cells, because the sperm cells that are injected are chosen randomly, without any natural selection. Increased prevalence of sex chromosomal anomalies (1In’t Veld P. Brandenburg H. Verhoeff A. Dhont M. Los F. Sex chromosomal abnormalities and intracytoplasmic sperm injection.Lancet. 1995; 346: 773Abstract PubMed Google Scholar) and a high prevalence of structural and numerical chromosomal aberrations (2Bonduelle M. Aytoz A. Van Assche E. Devroey P. Liebaers I. Van Steirteghem A. Incidence of chromosomal aberrations in children born after assisted reproduction through intracytoplasmic sperm injection.Hum Reprod. 1998; 13: 781-782Crossref PubMed Scopus (184) Google Scholar) have been reported. For these reasons invasive prenatal diagnosis (PND) is routinely offered to all our ICSI patients, in contrast with our IVF patients, who are only eligible for PND if they are 36 years of age or older or unless a special reason emerges. We hypothesized that a large proportion of ICSI patients is willing to undergo reliable prenatal testing for the detection of chromosomal abnormalities. All ICSI and IVF pregnancies that occurred in our clinic between September 1995 (start date of our ICSI program) and December 1999 are included in this study. Our ICSI patients were informed both orally and in writing about the risks of ICSI and PND by a gynecologist before the procedure. In addition, counseling by a geneticist is noncompulsory but strongly advised. During the study period, a total of 252 ICSI pregnancies (of 787 oocyte retrievals) were established in our clinic. Forty-four pregnancies (17%) ended in a spontaneous abortion before 10 weeks of gestation, and 3 pregnancies (1%) were ectopic. Of the 205 ongoing pregnancies (153 singletons, 52 twins), only 36 patients (17%) (24 singletons, 12 twins) chose invasive PND (5 chorion villus biopsy and 31 amniocentesis) (Table 1). Table 1Number of women pregnant after intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) who underwent invasive prenatal testing. legendvan der Westerlaken. Invasive prenatal diagnosis after ICSI. Fertil Steril 2001.Type of pregnancy, age of patientsNo. of pregnanciesNo. of ongoing pregnancies (%)No. of prenatal diagnoses (%)CVSAmniocentesisICSI, <36206169 (82)18 (11)315ICSI, ≥364636 (78)18 (50)216IVF, <36460355 (78)9 (2)36IVF, ≥36239166 (67)67 (40)265legend van der Westerlaken. Invasive prenatal diagnosis after ICSI. Fertil Steril 2001. Open table in a new tab In the same period, 699 IVF pregnancies (of 2,178 oocyte retrievals) were observed, 159 (23%) of which ended in a spontaneous abortion before 10 weeks of gestation and 13 of which (3%) were ectopic. Of the ongoing 521 pregnancies (373 singletons, 140 twins, and 8 triplets), 166 were eligible for PND based on age (131 singletons, 27 twins, 8 triplets) (Table 1), and of those 67 (40%) chose invasive PND (52 singletons, 13 twins, and 2 triplets). Only 9 pregnant IVF patients younger than 36 years were eligible for PND based on genetic disorders in the family history, and they all underwent invasive PND (6 singletons and 3 twins). Despite counseling (3Kocun C.C. Harrigan J.T. Canterino J.C. Feld S.M. Fernandez C.O. Changing trends in patient decisions concerning genetic amniocentesis.Am J Obstet Gynecol. 2000; 182: 1018-1020Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar) about the possible genetic risks, prenatal testing of ICSI pregnancies for detection of genetic abnormalities allegedly caused by the ICSI procedure itself is, at least among our patients, not popular in comparison with PND for ICSI or IVF pregnancies based on the indication of maternal age. Maternal age seems to be the predominant factor to consider when deciding whether to undergo invasive PND. This result might lead investigators to reconsider the policy of offering invasive prenatal testing in favor of noninvasive procedures (4Meschede D. Lemcke B. Stussel J. Louwen F. Horst J. Strong preference for non-invasive prenatal diagnosis in women pregnant through intracytoplasmic sperm injection (ICSI).Prenatal Diagn. 2000; 18: 700-705Crossref Scopus (27) Google Scholar).