Reproductive decisions of men with microdeletions of the Y chromosome: therole of genetic counselling

Couples dealing with microdeletions of the Y chromosome have to make decisi ons about their reproductive future. Do they opt for intracytoplasmic sperm injection (ICSI), artificial insemination with donor insemination (AID) or no treatment? We analysed this decision in 28 couples and investigated the role of the counsellor and the counselling process on the final decision o f the couple. Ten counsellors from six fertility clinics in The Netherlands and Belgium were interviewed about their genetic counselling of couples de aling with microdeletions. The answers to the questionnaire were converted to 11 dichotomous variables. Of the 1627 tested men in the six centres, 37 (2.3%) had a microdeletion in the AZFc region, a subregion of the AZF regio n on the Y chromosome important for normal spermatogenesis, The decisions o f 28 of them could be analysed. Most couples chose ICSI (79%). The remainin g couples chose donor insemination (7%) or refrained from treatment (14%), Several variables, including the counselling procedure, the counsellor and the available treatments in the fertility centre, influenced the decision o f the couple. In conclusion, most couples dealing with microdeletions in th e AZF region choose ICSI, Several aspects of the process of genetic counsel ling appear to be related to the final decision.