Use of testicular sperm for ICSI in oligozoospermic couples: how far should we go?
In 1992 and subsequently, several reports indicated that ICSI was a successful technique to achieve clinical pregnancy and live birth using spermatozoa with severely impaired characteristics. The initial optimism over the ability of ICSI to overcome significant sperm abnormalities was later tempered by the findings of more recent publications suggesting that some sperm deficits may not be as effectively treated with ICSI. In search for effective treatment for couples with severe male factor, a number of small retrospective and prospective studies have reported high pregnancy and live birth rates using testicular sperm for men with necrozoospermia, cryptozoospermia and oligozoospermia with or without elevated sperm DNA damage. Although the data suggest that there may be some benefit in performing testicular sperm retrieval (TSR)-ICSI in select groups of non-azoospermic infertile men, there are potential risks involved with TSR. Clinicians should balance these risks prior to the recommendation of TSR-ICSI on the result of a semen analysis or sperm DNA test alone. Careful evaluation and management of male factor infertility is important. The use of TSR-ICSI in the absence of specific sperm DNA defects is still experimental.
Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada ziniarmand@yahoo.com.
Armand
A
Zini
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Phil V
PV
Bach
Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada.
Ahmad H
AH
Al-Malki
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Peter N
PN
Schlegel
D001723:Birth Rate; D004249:DNA Damage; D005260:Female; D006801:Humans; D050498:Live Birth; D008297:Male; D009845:Oligospermia / Q000235:genetics*; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D016896:Treatment Outcome
ICSI; male infertility; sperm DNA; sperm retrieval; testicular sperm