The techniques of assisted reproduction have recently become the most effective methods of treatment of infertility; namely ICSI (intra-cytoplasmic sperm injection), MESA (microepididymal sperm aspiration), TESA (testicular sperm aspiration) and TESE (testicular sperm extraction). The techniques have been increasingly successful, even above the average efficiency of classical IVF (in vitro fertilization). It can be demonstrated by the percentage of ICSI-aided births percentage per 100% of embryotransfers in ISCARE; 1996 = 21.3%, 1997 = 26.15%, 1998 = 29.7%. The successful use of these techniques is associated with the rise of risks which result from the selection of couples for assisted reproduction with genetic-based infertility and with the rise of risks involving the introduction of genetic-based defects in to the next generation. Presently, a list of indications is being developed, which, while still not accepted officially, identifies patients for genetic counselling. Only the counselling center has the competence to estimate genetic risks over generations. Subsequently, after selection by the center, during 1997 and 1998 the chromosomes of 731 patients were cytogenetically examined, representing 429 infertile couples from the centres ISCARE, PRONATAL, FERTIMED, and CAR 1. LF UK. Within these 429 couples, belonging to four groups of indications, the cytogenetic examination was informative in 8.15%. This finding of a relatively high percentage (10 times more than in the general population) confirms the validity of the list of indications and the necessity of cooperation among the genetic counselling center, cytogenetic laboratory and the IVF centre.

Cytolab Praha