title: ICSI in cases of sperm DNA damage: beneficial effect of oral antioxidant treatment.
abstract: BACKGROUND
  Most studies examining the use of ICSI for cases of elevated sperm DNA fragmentation report poor pregnancy and implantation rates. ICSI with testicular sperm samples has recently been suggested for these cases. Here we test a less invasive approach based on oral antioxidant treatment prior to ICSI with ejaculated spermatozoa.
  
  
  METHODS
  Thirty-eight men with an elevated (> or =15%) percentage of DNA-fragmented spermatozoa in the ejaculate were treated with antioxidants (1 g vitamin C and 1 g vitamin E daily) for 2 months after one failed ICSI attempt. In 29 (76%) of these cases this treatment led to a decrease in the percentage of DNA-fragmented spermatozoa, and a second ICSI attempt was performed. Outcomes of the two attempts were compared.
  
  
  RESULTS
  No differences in fertilization and cleavage rates or in embryo morphology were found between the ICSI attempts performed before and after the antioxidant treatment. However, a marked improvement of clinical pregnancy (48.2% versus 6.9%) and implantation (19.6% versus 2.2%) rates was observed after the antioxidant treatment as compared with the pretreatment ICSI outcomes.
  
  
  CONCLUSIONS
  Oral antioxidant treatment appears to improve ICSI outcomes in those patiens with sperm DNA damage, in whom this treatment reduces the percentage of damaged spermatozoa.
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Rome, Italy.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Greco
authors.forename: Stefania
authors.initials: S
authors.lastname: Romano
authors.forename: Marcello
authors.initials: M
authors.lastname: Iacobelli
authors.forename: Susanna
authors.initials: S
authors.lastname: Ferrero
authors.forename: Elena
authors.initials: E
authors.lastname: Baroni
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Minasi
authors.forename: Filippo
authors.initials: F
authors.lastname: Ubaldi
authors.forename: Laura
authors.initials: L
authors.lastname: Rienzi
authors.forename: Jan
authors.initials: J
authors.lastname: Tesarik
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage*; D053938:DNA Fragmentation / Q000187:drug effects*; D005260:Female; D006801:Humans; D020287:In Situ Nick-End Labeling; D015994:Incidence; D007248:Infertility, Male / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D020554:Sperm Injections, Intracytoplasmic; D013094:Spermatozoa / Q000187:drug effects / Q000473:pathology*; D014810:Vitamin E / Q000008:administration & dosage
chemical_list: D000975:Antioxidants; D014810:Vitamin E; D001205:Ascorbic Acid