Testicular versus ejaculated sperm should be used for intracytoplasmic sperm injection (ICSI) in cases of infertility associated with sperm DNA fragmentation | Opinion: Yes

A treatment approach for couples with disrupted sperm DNA integrity and recurrent ART failure

“…ICSI would also be offered to men who, in spite of having spermatozoa with healthy chromatin, failed to achieve a pregnancy with standard in vitro insemination. Finally, for cases in which a pregnancy has not been achieved even with ICSI, men are counseled by a reproductive urologist and offered a cycle of ICSI using spermatozoa retrieved directly from the testicle [13, 14], where SCF appears to be consistently lower [15, 16].…”

“…Moreover, the correlation between motility, particularly the progressive type, and sperm chromatin integrity prompted us to investigate alternative and more conservative procedures. Among various options, microfluidic devices have been proposed to select more suitable spermatozoa [15, 17–20] with higher chromatin integrity and presumably greater fertilizing potential and an improved ability to support embryonic development. Since these novel devices can be sophisticated, expensive, and at times cumbersome, simpler methods have been tested.…”

Are specialized sperm function tests clinically useful in planning assisted reproductive technology?

“…A high SDF test result calls for action, which includes the treatment of underlying conditions to improve both sperm chromatin integrity and fertility prospects potentially. When no treatable condition is identified, consideration to ICSI with testicular sperm should be given (Figure-1) (24,36). However, given the risks associated with sperm retrieval (37)(38)(39)(40), ICSI with testicular sperm should be reserved for men with confirmed sperm DNA damage or severe oligozoospermia/cryptozoospermia (41); this is one of the reasons why testing is important.…”

“…A possible explanation for the better ICSI outcomes with testicular sperm relates to the ~3fold lower SDF in testicular specimens than ejaculated counterparts (24). The susceptibility of sperm chromatin to oxidative attack, particularly during epididymis transit, is well-established and might explain the low testicular sperm positivity for SDF among infertile men (25).…”

ICSI with testicular sperm for couples with sperm DNA damage

“…In this issue of the International Brazilian Journal of Urology, Dr. Sandro Esteves and Dr. Mark Sigman present the Pro and Con perspectives, respectively, of using testicular rather than ejaculated sperm in non-azoospermic couples with high sperm DNA fragmentation ( 20 , 21 ). Dr. Esteves discusses the adverse impact of sperm DNA damage on reproductive outcomes and demonstrates that sperm DNA damage is lower in testicular than in ejaculated sperm.…”