Icsi And Male Fertility

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Each technological conception of semen enables new strategies to further measure, define, control, and use sperm. Similar to the evolution of systems that define and classify normal sperm, semen manipulations have proliferated from the "low-tech" donor insemination, intracervi-cal, or intrauterine, to the "high-tech" intracytoplasmic sperm injection, where a single sperm cell is injected into an oocyte, commonly called an egg. These innovations related to human sperm are not isolated events but, rather, part of sweeping technical advances into human reproduction, with profound implications for men and masculinity.

Available since 1992, one of the most recent innovative procedures is intracytoplasmic sperm injection (ICSI).27 This procedure is performed by a physician for selecting a sperm cell from the testes or epi-didymides for direct injection into the egg. Now subfertile men (defined as those men who produce some sperm with the correct morphology and may eventually achieve pregnancy with a partner without medical intervention) as well as men with an infertility diagnosis (who are still able to produce a few sperm cells but are unlikely to achieve pregnancy) are able to participate in human reproduction. Notably, it is the women's body that must be treated through implantation of embryos to correct male infertility. ICSI has complex implications for men and masculinity: the immense power of ICSI to "restore" men's fertility (and, simultaneously, their masculinity) is undermined by the fact that real social barriers make ICSI available only to certain men. In reading scientific and popular accounts of ICSI, I have noted with interest the celebratory spin that is used to emphasize the effect of ICSI for infertile men. It is not unlike marketing messages used in ads for Rogaine and Viagra: "Hallelujah, you too can feel like a man again!"28

Increasing levels of male infertility have driven scientists to produce a variety of biomedical solutions, including ICSI and sperm cryopreser-vation. On their own, these solutions offer individual men the opportunity to reclaim or repair their masculinity. However, these technologies and treatments have the potential to be used in combination for very different purposes, again producing unintended consequences for men and threatening notions of hegemonic masculinity. For example, while ICSI is considered by some sperm banks to be a potential threat to their livelihood, it could also be seen as a boon to the sperm banking industry: as experts in the cryopreservation of sperm, these banks could use ICSI as an opportunity to expand their range of services. The combination of these technologies has the potential to make men unnecessary in reproduction. This seemingly sensational statement is based on a few simple facts: cryopreserved sperm has no known expiration date, sperm banks across the globe have hundreds of thousands of vials of semen with millions of sperm cells encapsulated in each vial, and ICSI only requires one sperm cell per injection in the ovum.

While the implication is that for the purpose of reproduction, actual men could be considered redundant, of course this interpretation of ICSI has revolutionary potential for the creation of families, the roles of men and women, and the organization of social power.29 How will actual men respond to this notion that previously procured sperm could be used to reproduce without them? Could this free-agent sperm cell now be a threat to actual men?

We need not wait until the discussion or application of this idea becomes commonplace, as many have already lamented the ways in which new reproductive technologies have obliterated the sanctity of fatherhood. For example, reactions to single women and lesbians choosing donor insemination (DI) to rear and raise children without men illustrates the supposed incredible threat that these families pose to fatherhood and masculinity (this is explored in chapter 3). In his scientific textbook, Reproductive Tissue Banking: Scientific Principles, Armand Karow suggests:

These technologies have caused Americans and many other people to ponder anew concepts of fatherhood, motherhood and childhood. Is it acceptable for a single woman, even a lesbian, to become pregnant with donor semen in order that she will not have to share parenthood with a man? . . . Should offending science be prohibited in the laboratory? Will these technologies explode into social catastrophe? Society evolves and matures in its understanding of its resources. At one time humans feared supernatural dragons of land, sea and air. Maturity and science conquered this fear and harnessed resources of nature.30

Judging from Karow's comments, "offending science," which allows even lesbians to get pregnant, was potentially destabilizing to an assumed sense of normality.

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