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Doctor Profile |
Christopher D. Williams, MD
Reproductive Medicine & Surgery Center of Virginia, PLC
Dr. Christopher Williams grew up in Reston, Va. He completed his undergraduate training at the College of William & Mary and received his medical degree from the University of Virginia. Dr. Williams completed his residency in Obstetrics and Gynecology at Carolinas Medical Center and a Fellowship in Reproductive Endocrinology and Infertility at The University of North Carolina. He is a Fellow of the American College of Obstetricians and Gynecologists, and sub-specialty certified in Reproductive Endocrinology and Infertility. Dr. Williams is the author of a fertility book for couples sold internationally, The Fastest Way to Get Pregnant Naturally. He is married and has two boys and a girl.
At the time ICSI was invented there were serious concerns about its safety. If you consider the situation for a moment you will understand why many reproductive specialists and ethicists were troubled. From a Darwinian perspective, the thought was that there must be a reason that the average human male sperm count is 60 million/ml. The assumption was that the strongest sperm must swim up and find the egg. Presumably, this engendered the highest-quality genetic information in the embryo. It was thought that merely choosing any random sperm to inject into an egg must lead to a higher risk of birth defects. From an evolutionary perspective, there was also a concern that men with severe oligospermia represented an evolutionary "dead end" for reproduction. In the minds of some ethicists, IVF with ICSI was altering nature. Another common concern was that men requiring ICSI were likely to have Y-chromosome microdeletions or other genetic problems that might be passed to a male child if pregnancy was successful. This would perpetuate a line of infertile men.
Over a decade later, most studies agree that the risk of genetic problems and birth defects is similar for ICSI babies compared to babies conceived through conventional fertilization during IVF. ICSI has opened the door to IVF for a large number of couples who are infertile due to severe oligospermia. Approximately 50 percent of couples undergoing IVF now benefit from ICSI. Although it may turn out to be true that a genetic line of sub-fertile men is being perpetuated, I have yet to meet a couple that have decided not to pursue ICSI due to this concern.
Preimplantation Genetic Diagnosis (PGD)
Preimplantation genetic diagnosis describes the biopsy of an embryo during the six- to 10-cell stage in order to diagnose genetic problems. This requires a couple to undergo IVF in order to allow embryo biopsy. PGD has shown great success when utilized for patients with known single gene defects (e.g., cystic fibrosis, muscular dystrophy) and chromosomal abnormalities, such as translocations. It has also been applied for the evaluation of aneuploidy in embryos at risk for karyotypic abnormalities, such as recurrent pregnancy loss, advanced maternal age, and repeat IVF failure.