Genetic counselling issues and male infertility

In the past few years, the major genetic causes of male infertility have been elucidated and many of these can now be treated using intracytoplasmic sperm injection (ICSI). This has raised a number of wider issues in the families of people with this type of infertility. Coupled with the essential need for individual (or family) confidentiality, this type of treatment demands a very careful and sensitive counselling approach. The main requirement is for fertility and genetic teams to collaborate to provide a person-oriented approach to the application of two very complex and intimidating technologies. An apparent difference between established fertility approaches and those of genetic teams relates to individual informed choice. The fertility team must address 'the welfare of the child' as is encapsulated in the Human Fertilisation and Embryology Authority (HFEA) Act of 1990. Since the welfare of the child is a subjective matter, decisions are often made by reproductive medicine ethics committees in conjunction with fertility teams. This aspect requires further development to include the ethos of genetic counselling, which is based more on individual informed choice for couples who have been provided with accurate information about the impact of a condition on a possible future child. The different ethical emphasis is not as great as it might initially appear. Ethics committees are now placing much more emphasis on a couple's autonomy in individual situations and, correspondingly, genetic centres are providing much more information about the possible effects of a couple's decision on the welfare of future children.