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Fertil Steril. 2017 Sep;108(3):456-467.e1. doi: 10.1016/j.fertnstert.2017.06.018.

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.

Author information

1
ANDROFERT, Center for Male Reproduction, São Paulo, Brazil. Electronic address: s.esteves@androfert.com.br.
2
ORIGEN, Center for Reproductive Medicine, Rio de Janeiro, Brazil.
3
Genea, Sydney, New South Wales, Australia.
4
IVI Foundation, Valencia, Spain.

Abstract

OBJECTIVE:

To compare sperm DNA fragmentation (SDF) levels between testicular and ejaculated sperm and to evaluate outcomes of intracytoplasmic sperm injection (ICSI) with the use of testicular (Testi-ICSI) versus ejaculated (Ejac-ICSI) sperm in nonazoospermic men with high SDF.

DESIGN:

Systematic review and meta-analysis.

SETTING:

Not applicable.

PATIENT(S):

Normo- and oligozoospermic men with high levels of SDF in semen subjected to Testi-ICSI or Ejac-ICSI.

INTERVENTION(S):

Summary mean difference (MD) and odds ratio (OR) were calculated with the use of an inverse variance model and fixed- or random-effects models, respectively.

MAIN OUTCOME MEASURE(S):

Primary outcomes were SDF levels, clinical pregnancy rates (CPRs), and live birth rates (LBRs). Secondary outcomes were fertilization and miscarriage rates.

RESULT(S):

Five studies involving 143 patients provided paired SDF rates for testicular and ejaculated sperm, revealing lower SDF in testicular sperm (MD -24.58%). Four studies involving 507 cycles and 3,840 oocytes reported clinical outcomes of Testi-ICSI and Ejac-ICSI. Fertilization rates were not different between sperm sources, but a trend to lower rates was observed with Testi-ICSI. CPRs were higher for Testi-ICSI than for Ejac-ICSI, as were LBRs, whereas miscarriage rates were reduced with Testi-ICSI.

CONCLUSION(S):

Testicular sperm have lower levels of SDF than ejaculated sperm, with Testi-ICSI for high post-testicular SDF men improving reproductive outcomes compared with Ejac-ICSI. Infertile couples may benefit from Testi-ICSI if male partners have confirmed high SDF in the ejaculate.

KEYWORDS:

Semen; intracytoplasmic sperm injection; male infertility; sperm DNA fragmentation; testicular sperm

[Indexed for MEDLINE]

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