Informing and counseling couples about pregnancy and birth after intracytoplasmatic sperm injection

Intracytoplasmic sperm injection (ICSI) is one of the most effective, invas ive means of treating infertility. Since couples undergoing ICSI have a hig her genetic risk than the general population,these genetic factors have to be taken into account (e.g., structural and numeric chromosomal aberrations or cystic fibrosis mutations). Only a small number of studies have satisfa ctorily evaluated the risk of de nova chromosomal aberrations in the offspr ing of such couples following an ICSI treatment. In these studies it was suspected that a higher risk of gonosomal aberratio ns was already present. This is - most likely - also a consequence of the u nderlying genetic risk in these couples. However, generally advising these women to submit to an invasive prenatal diagnostic procedure does not to be the correct conclusion from these data. Instead, pregnant women should be counseled about the possibilities as well as limitations of invasive and no ninvasive prenatal diagnostic procedures. Counseling should be conducted on an individual basis. A noninvasive approa ch of prenatal diagnosis includes nuchal translucency screening towards the end of the first trimester as well as a detailed ultrasound examination in the second trimester. After critical analysis of all available data on pre gnancies and births following ICSl, there does not seem to be any cause to counsel the couples about a higher rate of major malformations in their off spring as a consequence of ICSI. Furthermore, the development of these chil dren in the first 2 years of life is - insofar as has been evaluated - norm al in comparison to the general population. However,further studies should be conducted in the future, to collect more data,which should help in couns eling the prospective parents.