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The Use of Testicular Sperm for Intracytoplasmic Sperm Injection in Patients with High Sperm DNA Damage: A Systematic Review.
May 28, 2023
The Use of Testicular Sperm for Intracytoplasmic Sperm Injection in Patients with High Sperm DNA Damage: A Systematic Review.
Ambar RF, Agarwal A, Majzoub A, Vij S, Tadros NN, Cho CL, Parekh N, Borges E, Glina S.
World J Mens Health. 2021 Jul;39(3):391-398.
CAPSULE:
The use of testicular sperm with lower sperm DNA fragmentation (SDF) has been explored as a potential solution for unsuccessful ICSI cycles. However, it is important to critically evaluate the existing studies and understand the complex mechanisms of sperm DNA damage. While oxidative stress-induced DNA damage is commonly implicated, intratesticular alterations can also contribute to fragmented DNA in testicular sperm. Therefore, clinical management should prioritize strategies to lower SDF, rather than resorting to potentially harmful surgical sperm retrieval. Controlling exogenous factors, increasing ejaculation frequency, using antioxidants, and employing effective sperm selection methods can help reduce DNA fragmentation. While SDF may have little impact on ICSI pregnancy rates, it is associated with a higher miscarriage rate. However, these findings are based on heterogeneous studies using different SDF assays, making interpretation difficult. Most studies on testicular sperm and SDF have limitations, such as small sample sizes, lack of control groups, and inadequate reporting of live birth rates. Moreover, the mechanism of intratesticular DNA damage and its interaction with extratesticular pathways remain unclear. Further studies with rigorous designs, control groups, and appropriate outcomes are needed to determine the role of testicular sperm in non-azoospermic patients who have previously failed ICSI.