The advent of ICSI (intracytoplasmic sperm injection) two decades ago has enabled men with very low sperm counts to father children through IVF. Prior to this, as fertility specialists, we could offer these couples only donor sperm. Despite this "miracle" of modern medicine, one of the lingering concerns was as to whether using sperm from men with very low counts might lead to a more birth defects. Adding to this concern, were some studies suggesting that ICSI or even regular IVF might result in a higher than normal rate of abnormalities. Some good news, however. A recent study from the NIH suggests that this is not a concern. The researchers found that couples who conceived with very low sperm counts did not have children with more birth defects.