title: Higher pregnancy rates using testicular sperm in men with severe oligospermia.
abstract: OBJECTIVE
  To evaluate assisted reproductive technology (ART) outcomes using testicular sperm in oligospermic men who previously failed to achieve paternity using TUNEL-positive ejaculated sperm.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Twenty-four oligospermic men who failed one or more ART cycles using ejaculated sperm with TUNEL-positive proportion >7%, and subsequently underwent microsurgical testicular sperm extraction (TESE).
  
  
  METHODS
  TESE followed by intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  TUNEL-positive level in ejaculated and testicular sperm; clinical pregnancy.
  
  
  RESULTS
  The mean TUNEL-positive level was 24.5% for ejaculated sperm, and 4.6% for testicular sperm. Clinical pregnancy was achieved in the first ART cycle with testicular sperm in 12 (50%) out of 24 couples. There was no statistically significant difference in maternal and paternal age, maternal gravity and parity, number of previous ART attempts, concentration or motility of retrieved sperm, number of oocytes retrieved, fertilization rate, or number of embryos transferred between couples who did and did not achieve pregnancy. No miscarriages occurred. All 12 pregnancies resulted in the delivery of healthy children.
  
  
  CONCLUSIONS
  The percentage of TUNEL-positive cells is lower in testicular sperm for oligospermic men who have abnormal ejaculated sperm DNA fragmentation. The use of testicular sperm for ICSI was associated with a 50% pregnancy and live-birth rate for couples who had previously failed one or more IVF-ICSI cycles with ejaculated sperm. No other clinical predictors of successful pregnancies after the use of surgically retrieved sperm could be identified. In men with elevated TUNEL-positive ejaculated sperm and failed ART, TESE may be considered.
authors.affiliation: Department of Urology, Cornell Medical College, New York, New York; Department of Urology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: akanksha.mehta@emory.edu.
authors.forename: Akanksha
authors.initials: A
authors.lastname: Mehta
authors.affiliation: Department of Urology, Cornell Medical College, New York, New York.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bolyakov
authors.affiliation: Department of Urology, Cornell Medical College, New York, New York.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
authors.affiliation: Department of Urology, Cornell Medical College, New York, New York.
authors.forename: Darius A
authors.initials: DA
authors.lastname: Paduch
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D017209:Apoptosis; D053938:DNA Fragmentation; D005260:Female; D005298:Fertility; D006801:Humans; D020287:In Situ Nick-End Labeling; D050498:Live Birth; D008297:Male; D008875:Middle Aged; D009845:Oligospermia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013076:Sperm Count; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D013094:Spermatozoa / Q000473:pathology*; D016896:Treatment Outcome
keywords: Infertility; TESE; recurrent pregnancy loss; sperm DNA fragmentation; terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay; testicular sperm extraction