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Volume 22, Issue 4 (July 2020) 22, 348–353; 10.4103/aja.aja_99_19

Use of testicular sperm in couples with SCSA-defined high sperm DNA fragmentation and failed intracytoplasmic sperm injection using ejaculated sperm

Mohannad Alharbi1,2, Fadl Hamouche1, Simon Phillips3, Jacques Isaac Kadoch3,4, Armand Zini1,3

1 Division of Urology, Department of Surgery, McGill University, Montreal H4A3J1, Canada
2 Department of Urology, College of Medicine, Qassim University, Qassim 1162, Saudi Arabia
3 OVO Fertility Clinic, Montreal H4P2S4, Canada
4 Department of Obstetrics and Gynecology, University of Montreal, Montreal H3C3J7, Canada

Correspondence: Dr. A Zini (ziniarmand@yahoo.com)

Date of Submission 11-Feb-2019 Date of Acceptance 11-Jul-2019 Date of Web Publication 27-Sep-2019


Sperm DNA fragmentation (SDF) has been linked with male infertility, and previous studies suggest that SDF can have negative influence on pregnancy outcomes with assisted reproduction. We performed a retrospective review of consecutive couples with a high SDF level that had intracytoplasmic sperm injection (ICSI) using testicular sperm (T-ICSI). We compared the T-ICSI outcomes to that of two control groups: 87 couples with failed first ICSI cycle and who had a second ICSI cycle using ejaculated sperm (Ej-ICSI), and 48 consecutive couples with high sperm chromatin structure assay (SCSA)-defined SDF (>15%) that underwent an ICSI cycle using ejaculated sperm after one or more failed ICSI cycles (Ej-ICSI-high SDF). The mean number of oocytes that were retrieved and the total number of embryos were not different among the three groups. The mean number of transferred embryos in the T-ICSI group was higher than the Ej-ICSI group but not significantly different than the Ej-ICSI-high SDF group (1.4, 1.2, and 1.3, respectively, P < 0.05). Clinical pregnancy rate in the T-ICSI group was not significantly different than the Ej-ICSI and Ej-ICSI-high SDF groups (48.6%, 48.2%, and 38.7%, respectively, P > 0.05). No significant difference was found in live birth rate when comparing T-ICSI to Ej-ICSI and Ej-ICSI-high SDF groups. The results suggest that pregnancy outcomes and live birth rates with T-ICSI are not significantly superior to Ej-ICSI in patients with an elevated SCSA-defined sperm DNA fragmentation and prior ICSI failure(s).

Keywords: intracytoplasmic sperm injection; male infertility; sperm chromatin structure assay; sperm DNA fragmentation; sperm retrieval; testicular sperm

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