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from Section VI - Male-factor Infertility
Published online by Cambridge University Press: 25 November 2021
For couples with repeated ICSI failure, there is currently no further treatment option for men wishing to father their own biological child. Men with high damage in their ejaculated sperm have less DNA damage in their testicular and epididymal sperm. Live birth rates are higher in Testi-ICSI than conventional ICSI for couples with repeated ICSI failure, and PICSI and IMSI are less successful than Testi-ISCI. ICSI with testicular sperm should NOT be offered to men with untested sperm DNA as evidence of benefit is ambivalent. In order to ensure that testicular sperm are indeed of better genomic quality than their ejaculate counterparts, diagnostic testing is required to avoid invasive biopsy unless indicated. Prior to Testi-ICSI, men should have clinical histories and examinations and all other causes of sperm DNA damage should be treated. A major confounding factor in assessing the benefits of Testi-ICSI with conventional ICSI is female age.
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