37B - Testicular Sperm Should Be Considered for Repeated ICSI Failed Implantation Cases in Men with High DNA Damage

Summary

Utilising ejaculated sperm with an elevated sperm DNA fragmentation (SDF) has been found to result in poor ICSI outcomes. Ejaculated sperm from the epididymis is more prone to DNA damage, due to the oxidative stress associated with epididymal transit as described by Esteves et al. [1], who found a DNA fragmentation index (DFI) of 8.3% in testicular sperm versus 40.7% in ejaculated sperm. Similar findings were reported by Greco et al. With this knowledge many clinicians are increasingly inclined to perform ICSI with testicular sperm in patients with failed implantation and high levels of DNA damage. However, no randomised controlled trials have documented the benefit of using testicular compared to ejaculated sperm [2]. In contrast, despite the lower SDF in testicular sperm, Moskovtsev et al. showed that testicular sperm have 2-3-fold higher aneuploidy rates than ejaculated samples. These results have been contested, though, in a recent study in which the rates of aneuploidy in testicular sperm were not higher than ejaculated sperm. Yet, it is important to recognise that the studies concerning aneuploidy have small samples and are inconclusive.