ICSI outcome in patients with high DNA fragmentation: Testicular versus ejaculated spermatozoa

Abstract

Sperm DNA fragmentation (SDF) has emerged as an important biomarker in the assessment of male fertility potential with contradictory results regarding its effect on ICSI. The aim of this study was to evaluate intracytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular versus ejaculated spermatozoa. This is a prospective study on 36 men with high-SDF levels who had a previous ICSI cycle from their ejaculates. A subsequent ICSI cycle was performed using spermatozoa retrieved through testicular sperm aspiration. Results of the prior ejaculate ICSI were compared with those of the TESA-ICSI. The mean (SD) SDF level was 56.36% (15.3%). Overall, there was no difference in the fertilization rate and embryo grading using ejaculate and testicular spermatozoa (46.4% vs. 47.8%, 50.2% vs. 53.4% respectively). However, clinical pregnancy was significantly higher in TESA group compared to ejaculated group (38.89% [14 of 36] vs. 13.8% [five of 36]). Moreover, 17 live births were documented in TESA group, and only three live births were documented in ejaculate group (p < .0001). We concluded that the use of testicular spermatozoa for ICSI significantly increases clinical pregnancy rate as well as live-birth rate in patients with high SDF.

A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment

“…Our experience has evidenced that even in the most severe cases of DNA fragmentation, the incidence of SDF progressively decreases when samples are retrieved from the proximal sites of the male genital tract, resulting in almost consistently normal SDF in the testicle. When comparing semen source, there is a clear improvement in clinical outcome utilizing testicular and epididymal spermatozoa in comparison to the ejaculated counterpart, supporting the concept that sperm chromatin integrity degrades post-testis in transit through the male genital tract [ 12 ]. While the option of repeating an ICSI attempt with ejaculated spermatozoa is still valid, the decision to use surgically retrieved spermatozoa is becoming more accepted.…”

“…Indeed, a recent guideline on the utility of DNA fragmentation testing in the clinical setting suggested that patients with poor IUI outcomes should be offered the option for SDF assessment as the results could expedite eventual treatment by IVF or ICSI [ 10 ]. More recent studies on the treatment of men with high SDF in their ejaculated spermatozoa experienced improved clinical outcome by using surgically retrieved spermatozoa, noted to have higher chromatin integrity [ 11 , 12 ]. Thus, this simple test to screen the condition of the gamete genome is increasingly becoming recognized as a useful tool to assess the fertility of the male partner.…”

European Academy of Andrology guideline Management of oligo‐astheno‐teratozoospermia

“…In some cases of OAT managed unsuccessfully with ICSI, an increased DNA damage was found in the spermatozoa from ejaculate. Data are emerging about a lower percentage of spermatozoa with DNA fragmentation recovered from testis by TESE or TESA compared with spermatozoa from ejaculate in these populations (Greco et al ., ; Arafa et al ., ). However, good evidence from randomized studies on clinical pregnancy rates and live birth rates is still missing (Esteves et al ., ).…”

Male Infertility is a Women’s Health Issue—Research and Clinical Evaluation of Male Infertility Is Needed

“…If the DNA fragmentation index is elevated, there are several potential treatments. These treatments include follicle-stimulating hormone (FSH) [1], magnetic assisted cell sorting (MACS) that may help select sperm with high-quality DNA [62], and retrieval of testicular sperm (known as testicular sperm extraction, TESE, or testicular sperm aspiration, TESA) for use with ICSI [63,64]. The diagnosis and treatments for DNA fragmentation have not been fully validated using randomized control trials.…”