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A Clinician's Guide to Sperm DNA and Chromatin Damage pp 545–557Cite as

Use of Testicular Sperm for ICSI: Pro

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Abstract

Spermatozoa retrieved from the testis of men with high levels of seminal sperm DNA fragmentation (SDF) tend to have better DNA quality. Given the negative impact of SDF on assisted reproductive technology (ART) outcomes, an increased interest has emerged about the use of testicular sperm for intracytoplasmic sperm injection (TESTI-ICSI). In this chapter, we used a SWOT (strengths, weaknesses, opportunities, and threats) analysis to summarize the advantages and drawbacks of this type of intervention. The rationale of using TESTI-ICSI is to bypass post-testicular induced DNA fragmentation that occurs mainly by reactive oxygen species (ROS) during sperm transport through the epididymis. As a matter of fact, testicular sperm are shown to have three- to fivefold lower DNA fragmentation than ejaculated sperm. The strength of this method is to maximize oocyte fertilization by genomically intact testicular spermatozoa and to increase the chances of creating a normal embryonic genome and the likelihood of live birth, as recently demonstrated. The weaknesses are the limited evidence available and the invasiveness of sperm retrieval, which has potential complications. However, ample opportunities exist to investigate the effectiveness of TESTI-ICSI in other patient subsets, including cryptozoospermia, repeated implantation failure, and repeated miscarriage, as well as to compare TESTI-ICSI to other laboratory preparation methods used to deselect sperm with damaged DNA. Lastly, the threats relate to the possibility of using testicular sperm with putative deficiencies that would be blocked in its ontogeny during the maturation process. In conclusion, current data indicate that the use of testicular sperm is associated with improved ICSI outcomes in men with oligozoospermia and high SDF. Testicular sperm retrieval should be considered when performing ICSI in such cases, provided less invasive treatments for alleviating DNA damage have failed. A call for continuous monitoring is nonetheless required until the safety of this strategy to the health of offspring is confirmed.

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Authors and Affiliations

  1. Andrology and Human Reproduction Clinic, ANDROFERT, Campinas, Brazil

    Sandro C. Esteves

  2. ORIGEN - Center for Reproductive Medicine, Rio de Janeiro, RJ, Brazil

    Matheus Roque

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  1. Sandro C. Esteves
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  2. Matheus Roque
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Correspondence to Sandro C. Esteves .

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Editors and Affiliations

  1. Department of Surgery, Division of Urology, McGill University, Montreal, Québec, Canada

    Armand Zini

  2. American Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Ashok Agarwal

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Esteves, S.C., Roque, M. (2018). Use of Testicular Sperm for ICSI: Pro. In: Zini, A., Agarwal, A. (eds) A Clinician's Guide to Sperm DNA and Chromatin Damage. Springer, Cham. https://doi.org/10.1007/978-3-319-71815-6_29

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  • DOI: https://doi.org/10.1007/978-3-319-71815-6_29

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