Testicular Sperm in Non-azoospermic Infertile Men with Oxidatively Induced High Sperm DNA Damage

Abstract

Given the essential role of sperm DNA integrity for normal embryo development and pregnancy outcome, all efforts should be made to properly counsel infertile men about risks of using sperm with high sperm DNA fragmentation (SDF) for both natural and assisted insemination. Many conditions associated with SDF are modifiable, including varicocele, lifestyle factors, and genital infections. Correction of underlying factors might alleviate SDF and potentially enable natural conception or increase the likelihood of pregnancy by assisted reproductive technology (ART). However, when SDF remains high after treatment of the underlying factors or no obvious condition is identified to allow treatment, the use of testicular sperm in preference over ejaculated sperm for ICSI is a valid strategy to overcome the oxidatively induced SDF. Current evidence overwhelmingly based on cohort studies suggests the safe utilization of testicular sperm for ICSI in non-azoospermic men with high SDF in semen. Further research is warranted to confirm the clinical utility of this approach in the ART settings.