How can birth defects be reduced in assisted reproduction?

This paper compared the rates of birth defects in babies born after intracytoplasmic sperm injection and after sperm were chosen for at high magnification. 

Intracytoplasmic sperm injection (injecting sperm directly into egg) is an effective reproductive method to treat male infertility. However, there is an increased rate of major malformations (defects in the offspring). It is suggested that this is because the single sperm cells chosen for intracytoplasmic sperm injection may have abnormalities that are not easily detected under normal microscope conditions. 

Selecting the best sperm cell to use in intracytoplasmic sperm injection may be achieved by using very high magnification, allowing a clearer picture of the makeup of the cell, to choose sperm cells without abnormalities. After a normal-looking sperm is chosen, it is injected directly into the egg as per usual. It is suggested that choosing sperm at high magnification can minimize malformations.

This study aimed  to evaluate the differences in children born after normal intracytoplasmic sperm injection, and those born after intracytoplasmic injection of carefully selected sperm.

The study analyzed 578 infants conceived through intracytoplasmic sperm injection and 450 infants conceived after sperm was chosen at high magnification.  Fertilization rate was 80.6% among children born after sperm was chosen at high magnification. Fertilization rate was 77.7% among children born through normal intracytoplasmic sperm injection. 

3.8% of children born after normal intracytoplasmic sperm injection had major malformations affecting mainly the urinary and genital systems and heart. 1.33% of children born after sperm was chosen at high magnification had major malformations. These malformations were urinary tract problems, polydactyly (abnormal number of fingers), club feet (abnormal feet position) and diaphragmatic hernia (abnormal opening in diaphragm). Most of the defects occurred in women older than 30 years.

The authors concluded that choosing suitable sperm for intracytoplasmic sperm injection at high magnification minimizes the risk of major birth defects in offspring.

Discuss with your doctor the benefits that may be associated with careful and specific selection of sperm cells for use in intracytoplasmic sperm injection.