Use of testicular sperm for ICSI in oligozoospermic couples: how far should we go?

Abstract

In 1992 and subsequently, several reports indicated that ICSI was a successful technique to achieve clinical pregnancy and live birth using spermatozoa with severely impaired characteristics. The initial optimism over the ability of ICSI to overcome significant sperm abnormalities was later tempered by the findings of more recent publications suggesting that some sperm deficits may not be as effectively treated with ICSI. In search for effective treatment for couples with severe male factor, a number of small retrospective and prospective studies have reported high pregnancy and live birth rates using testicular sperm for men with necrozoospermia, cryptozoospermia and oligozoospermia with or without elevated sperm DNA damage. Although the data suggest that there may be some benefit in performing testicular sperm retrieval (TSR)-ICSI in select groups of non-azoospermic infertile men, there are potential risks involved with TSR. Clinicians should balance these risks prior to the recommendation of TSR-ICSI on the result of a semen analysis or sperm DNA test alone. Careful evaluation and management of male factor infertility is important. The use of TSR-ICSI in the absence of specific sperm DNA defects is still experimental.

Coffee and caffeine intake and male infertility: a systematic review

“…Noteworthy, the inconsistencies among available evidence are not surprising and may be explained by methodological issues. In fact, a burning debate currently exists on the use of sperm DNA damage tests in the infertility work-up of men, because of poor reproducibility [19, 20]. The availability of numerous assays to measure sperm DNA damage and the lack of well-designed comparative diagnostic studies have hampered, up to now, standardization and the full understanding of the clinical implications of sperm DNA damage [20].…”

“…This aspect is of potential relevance, considering that human sperm DNA damage can also be determined by testicular or post-testicular injury including oxidative stress [19]. Available evidence indicates that semen samples containing a percentage of DNA fragmented cells above a critical threshold have a reduced level of pregnancy success [20, 21]. …”

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

“…Therefore, despite the controversy as to which sperm DNA assay and threshold values should be adopted clinically, our results suggest that Testi-ICSI is beneficial when SDF values exceed 29%. However, any decision to consider Testi-ICSI should take into account the limitations of SDF testing and the possible benefits for clinical outcomes (55). It is therefore essential that a reliable SDF assay with a validated threshold be used.…”

Morphology of Spermatozoids and Features of Male Endocrine Status in Men Working with Agricultural Fertilizers

“…В ряді країн та регіонів Європи, Америки та Азії опубліковані ретроспективні порівняльні дослідження, більшість з яких підтверджує висновок про зниження якості сперми чоловіків за останні десятиліття. Епідеміологічні дослідження також показують, що етнічні особливості якості сперми можуть вносити істотний вклад в регіональну мінливість чоловічої фертильності [5,7].…”