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37B - Testicular Sperm Should Be Considered for Repeated ICSI Failed Implantation Cases in Men with High DNA Damage


from Section VI - Male-factor Infertility

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Homerton University Hospital, London
Adam H. Balen
Leeds Centre for Reproductive Medicine
Robert F. Casper
Mount Sinai Hospital, Toronto
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Utilising ejaculated sperm with an elevated sperm DNA fragmentation (SDF) has been found to result in poor ICSI outcomes. Ejaculated sperm from the epididymis is more prone to DNA damage, due to the oxidative stress associated with epididymal transit as described by Esteves et al. [1], who found a DNA fragmentation index (DFI) of 8.3% in testicular sperm versus 40.7% in ejaculated sperm. Similar findings were reported by Greco et al. With this knowledge many clinicians are increasingly inclined to perform ICSI with testicular sperm in patients with failed implantation and high levels of DNA damage. However, no randomised controlled trials have documented the benefit of using testicular compared to ejaculated sperm [2]. In contrast, despite the lower SDF in testicular sperm, Moskovtsev et al. showed that testicular sperm have 2-3-fold higher aneuploidy rates than ejaculated samples. These results have been contested, though, in a recent study in which the rates of aneuploidy in testicular sperm were not higher than ejaculated sperm. Yet, it is important to recognise that the studies concerning aneuploidy have small samples and are inconclusive.

Publisher: Cambridge University Press
Print publication year: 2021

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Esteves, SC, Sánchez-Martin, F, Sánchez-Martin, P, et al. Comparison of reproductive outcome in oligozoospermic men with high sperm DNA fragmentation undergoing intracytoplasmic sperm injection with ejaculated and testicular sperm. Fertil Steril. 2015;104(6):1398–405.CrossRefGoogle ScholarPubMed
Greco, E, Scarselli, F, Iacobelli, M, et al. Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular spermatozoa. Hum Reprod. 2005;20(1):226–30.Google ScholarPubMed
Halpern, JA, Schlegel, PN. Should a couple with failed in vitro fertilization/intracytoplasmic sperm injection and increased sperm DNA fragmentation use testicular sperm for the next cycle? Eur Urol Focus. 2018;4(3):299300.CrossRefGoogle ScholarPubMed
Moskovtsev, SI, Alladin, N, Lo, KC, et al. A comparison of ejaculated and testicular spermatozoa aneuploidy rates in patients with high sperm DNA damage. Syst Biol Reprod Med. 2012;58(3):142–8.CrossRefGoogle ScholarPubMed
Abhyankar, N, Kathrins, M, Niederberger, C. Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia: a meta-analysis. Fertil Steril. 2016;105(6):1469–75.e1.CrossRefGoogle ScholarPubMed
Alharbi, M, Almarzouq, A, Zini, A. Sperm retrieval and intracytoplasmic sperm injection outcomes with testicular sperm aspiration in men with severe oligozoospermia and cryptozoospermia. Can Urol Assoc J. 2021;15(5):E272–5.Google ScholarPubMed
Awaga, HA, Bosdou, JK, Goulis, DG, et al. Testicular versus ejaculated spermatozoa for ICSI in patients without azoospermia: A systematic review. Reprod Biomed. Online, 2018;37(5):573–80.CrossRefGoogle ScholarPubMed

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