Q: I've heard that some fertility treatments can cause abnormalities in the fetus. Is this true? I'm worried because I'm having in vitro fertilization (IVF) in a few weeks.
A: You may be referring to a procedure called intracytoplasmic sperm injection, or ICSI, which is often done in conjunction with IVF. While research shows it might increase the risk of chromosomal abnormalities, that risk is slight, says Paolo Rinaudo, M.D., Ph.D., an assistant professor of obstetrics-gynecology and reproductive sciences at the University of California, San Francisco. "One study showed that inherited chromosomal abnormalities occur in 0.3 percent to 0.4 percent of the general population," Rinaudo explains. "After ICSI, the rate was 1.4 percent." He adds that non-inherited abnormalities increase from 0.5 percent to 1.6 percent after the procedure—similar to the risk a 40-year-old woman who has a child faces. With standard IVF, a batch of sperm is added to the woman's egg (or eggs) in a laboratory and fertilization is allowed to occur on its own. With ICSI, one sperm is selected and inserted into an egg, making it easier for fertilization to take place. ICSI is used when a man has suboptimal sperm, so the theory is that he may be passing on some underlying problems—hence the increase in abnormalities. Plus, as Rinaudo says, "By bypassing normal events, molecular development could be altered." While Rinaudo believes that ICSI is overwhelmingly safe, he nonetheless feels that until more is known, it should be used only when medically indicated, not routinely.