Genetic risk in micromanipulative assisted reproduction

The empirical data on pregnancy outcome after intracytoplasmic sperm injection (ICSI) are encouraging, but still insufficient to rule out definitely adverse genetic or teratological effects. We analyse potential adverse effects of ICSI by applying general principles of genetic and teratological risk assessment. The role of gamete micromanipulation as a possible teratogen is discussed. We consider whether ICSI patients are at increased risk for carrying and propagating genetic lesions of different kinds. The possible interference of ICSI with genomic imprinting and pre-zygotic sperm selection is reviewed and we discuss the potentially protective role of DNA repair in oocytes. Considering the available empirical data and the conclusions from our theoretical analysis it appears that neither lassitude nor over-concern about adverse effects of ICSI are justified.