The June 1 Better Health newsletter mentioned a study in the Lancet (May 23, 1998), as follows: "Children conceived using ICSI (a technique for fertilizing an egg by injecting a sperm directly into it) show a higher rate of cognitive developmental delay than children conceived using other methods." What are your comments on that study? I'm scheduled for IVF with ICSI next month.

-- Renee

The May 23 issue of Lancet included two studies that looked at this topic. The first, a small, poorly controlled study comparing groups that were not really similar, showed that ICSI babies may show developmental delays. This is the study you mention. The study stated that there were significant differences in the ages of the parents, their level of educational status, use of English language (which may confound testing), and frequency of admission to a neonatal intensive care unit. IVF and ICSI babies appeared to weigh less, although the results did not achieve statistical significance due to the very small sample size.

However, a much larger, more appropriately designed study reported in the same issue of Lancet concluded otherwise. In their report, these researchers stated, "The overall results for ICSI and IVF children indicate a score no lower than that for the general population. In multiple pregnancies, results were somewhat lower than for singletons, with no indication of lower scores in the ICSI group than in the IVF group."

In any case, information on this topic is far from complete. The researchers of the second study wrote, "There is no indication that ICSI children have a slower mental development than the general population, although a detailed case-control study taking into account parental background is needed to be able to draw final conclusions."

In addition to taking into account the status of the parents and the issues of gestational age, multiple births and prematurity, it's important to consider the reason couples choose ICSI in the first place. A small percentages of males who come to ICSI are found to have chromosomal or DNA abnormalites on the Y chromosome that may be passed on to male offspring. What this means is that any of a number of factors can interfere. In other words, if there is an adverse outcome, that doesn't necessarily mean the procedure is at fault; other factors may be at issue.