Testicular versus ejaculated spermatozoa in ICSI cycles of normozoospermic men with high sperm DNA fragmentation and previous ART failures

Abstract

As a part of male assessment, conventional sperm parameters including morphologic features have been dedicated as major factors influencing fertilisation and pregnancy rates in assisted reproductive technology (ART). Genomic integrity of spermatozoa has also been found to influence fertility prognosis, and hence, sperm DNA fragmentation index (DFI) has been adopted by many centres to document this entity. Despite several suggested approaches, there is lack of universal consensus on optimising fertility outcomes in males with high sperm DFI. In this context, the results from cycles using testicular spermatozoa (TESA) obtained by aspiration were compared with those of ejaculated spermatozoa (EJ) in normozoospermic subjects with high sperm DFI and previous ART failures. Clinical (41.9% versus 20%) and ongoing pregnancy rates (38.7% versus 15%) were significantly better and miscarriages were lower in TESA group when compared to EJ group. Sperm DFI should be a part of male partner's evaluation following unsuccessful ART attempts. When high DFI is detected (>30%), ICSI using testicular spermatozoa obtained by TESA seems an effective option particularly for those with repeated ART failures in terms of clinical, ongoing pregnancies and miscarriages even though conventional sperm parameters are within normal range.

Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios

“…The authors also found that SDF assessed by the SCD method was 5-fold lower in testicular sperm than in ejaculated sperm (40.7%±9.9% vs. 8.3%±5.3%; P<0.001). In another study of similar design but involving normozoospermic men with high SDF, the fertilization rate and miscarriage rate did not differ; however, a significantly higher pregnancy rate was reported in testicular sperm cycles (85). …”

Reproductive outcomes of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with high levels of DNA fragmentation in semen: systematic review and meta-analysis

“…Four studies (32,34,36,45) provided fertilization data for 3,840 oocytes injected with either testicular sperm or ejaculated sperm in high-SDF patients. The mean twopronuclei fertilization rates with the use of Testi-ICSI and Ejac-ICSI were 59.8% and 68.7% (P< .001), respectively.…”

Factors associated with the success of intracytoplasmic sperm injection for the treatment of conjugal infertility

“…However, some authors showed conflicting results about the issue. 16 In this study, almost 2/3 of viable pregnancies happened in women who had more than eight oocytes retrieved. According to some authors, 17 the live births rate significantly increases with the number of retrieved oocytes.…”