title: Comparison of reproductive outcome in oligozoospermic men with high sperm DNA fragmentation undergoing intracytoplasmic sperm injection with ejaculated and testicular sperm.
abstract: OBJECTIVE
  To investigate the effectiveness of intracytoplasmic sperm injection (ICSI) using testicular sperm as a strategy to overcome infertility in men with high sperm DNA fragmentation (SDF).
  
  
  METHODS
  Prospective, observational, cohort study.
  
  
  METHODS
  Private IVF centers.
  
  
  METHODS
  A total of 147 couples undergoing IVF-ICSI and day 3 fresh ETs whose male partner has oligozoospermia and high SDF.
  
  
  METHODS
  Sperm injections were carried out with ejaculated sperm (EJA-ICSI) or testicular sperm (TESTI-ICSI) retrieved by either testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). SDF levels were reassessed on the day of oocyte retrieval in both ejaculated and testicular specimens.
  
  
  METHODS
  Percentage of testicular and ejaculated spermatozoa containing fragmented DNA (%DFI) and clinical pregnancy, miscarriage, and live-birth rates.
  
  
  RESULTS
  The %DFI in testicular sperm was 8.3%, compared with 40.7% in ejaculated sperm. For the TESTI-ICSI group versus the EJA-ICSI group, respectively, the clinical pregnancy rate was 51.9% and 40.2%, the miscarriage rate was 10.0% and 34.3%, and the live-birth rate was 46.7% and 26.4%.
  
  
  CONCLUSIONS
  ICSI outcomes were significantly better in the group of men who had testicular sperm used for ICSI compared with those with ejaculated sperm. SDF was significantly lower in testicular specimens compared with ejaculated counterparts. Our results suggest that TESTI-ICSI is an effective option to overcome infertility when applied to selected men with oligozoospermia and high ejaculated SDF levels.
authors.affiliation: Androfert, Andrology and Human Reproduction Clinic, Campinas, Brazil. Electronic address: s.esteves@androfert.com.br.
authors.forename: Sandro C
authors.initials: SC
authors.lastname: Esteves
authors.affiliation: Ginemed, Seville, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Sánchez-Martín
authors.affiliation: Ginemed, Seville, Spain.
authors.forename: Pascual
authors.initials: P
authors.lastname: Sánchez-Martín
authors.affiliation: Androfert, Andrology and Human Reproduction Clinic, Campinas, Brazil.
authors.forename: Danielle T
authors.initials: DT
authors.lastname: Schneider
authors.affiliation: Unit of Genetics, Department of Biology, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Gosálvez
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D001938:Brazil; D053938:DNA Fragmentation; D004542:Ejaculation; D005260:Female; D005298:Fertility; D006801:Humans; D050498:Live Birth; D008297:Male; D009845:Oligospermia / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D013030:Spain; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects; D053625:Sperm Retrieval / Q000009:adverse effects; D013094:Spermatozoa / Q000473:pathology*; D016896:Treatment Outcome
keywords: Ejaculation; infertility; intracytoplasmic sperm injection; male/therapy; sperm DNA fragmentation; sperm retrieval