Testicular sperm for intracytoplasmic sperm injection in non-azoospermic men: a paradigm shift

In recent years, growing evidence has challenged the notion that sperm quantity and quality are not essential for the success of assisted reproductive technology. DNA fragmentation assessments on ejaculated and testicular sperm harvested from non-azoospermic infertile men have reported a remarkable decrease in DNA damage in spermatozoa directly retrieved from the seminiferous tubules. Moreover, emerging evidence using molecular genetic techniques indicates that aneuploidy rates are lower in testicular sperm than in ejaculated counterparts. The use of testicular sperm from non-azoospermic men with high sperm DNA fragmentation in semen has translated into a higher pregnancy rate and reduced risk of miscarriage. In light of these observations, the time have come for a paradigm shift concerning the use of ejaculated sperm as the preferable source of sperm for intracytoplasmic sperm injection (ICSI). Despite the need for further confirmatory research, the current evidence corroborates the safe utilization of testicular spermatozoa for ICSI in non-azoospermic men with high sperm DNA fragmentation in semen with a positive impact on chances of pregnancy.