—Dr Tripp and colleagues highlight some important aspects raised by our article summarizing the outcome of the ICSI procedure. There have been 2 major concerns related to ICSI. One concern is the invasive nature of the procedure, but this approach now seems entirely compatible with normal development. Based on our results, it is clear that the manipulative technique of ICSI per se can no longer be regarded as an experimental procedure.1 A second concern has been the necessary selection of spermatozoa from men with incomplete development of the excurrent duct system related to cystic fibrosis or of immature male germ cells in which ICSI is applied to the treatment of severely oligozoospermic or azoospermic men. This is not the first time that concerns have been raised about the use of suboptimal semen in assisted fertilization. However, among the conditions mentioned by Tripp et al, the incidence of hypospadias after
Palermo GD, Colombero LT, Schattman GL, Davis OK, Rosenwaks Z. Intracytoplasmic Sperm Injection and Potential Transmission of Genetic Disease-Reply. JAMA. 1997;277(12):964. doi:10.1001/jama.1997.03540360032021
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