Superior Live Birth Rates, Reducing Sperm DNA Fragmentation (SDF), and Lowering Miscarriage Rates by Using Testicular...

Area of Science:

• Reproductive Medicine
• Genetics
• Infertility Research

Background:

• Elevated sperm DNA fragmentation (SDF) and prior intracytoplasmic sperm injection (ICSI) failures are significant challenges in male infertility.
• Testicular sperm may offer an alternative with potentially lower DNA damage compared to ejaculated sperm.

Purpose of the Study:

• To compare sperm DNA fragmentation (SDF) levels between ejaculate and testicular sperm.
• To evaluate the clinical outcomes of ICSI using testicular sperm (T-ICSI) versus ejaculate sperm (E-ICSI) in males with specific infertility factors.

Main Methods:

• A systematic review and meta-analysis of thirteen studies were conducted.
• Outcomes analyzed included SDF levels, fertilization rate (FR), clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR).
• Statistical analysis involved calculating mean differences (MD) and odds ratios (OR).

Main Results:

• Testicular sperm exhibited significantly lower SDF levels compared to ejaculated sperm (MD = -25.42).
• T-ICSI cycles showed significantly higher CPR (OR = 2.13), lower MR (OR = 0.31), and increased LBR (OR = 2.40).
• No significant overall difference in FR was observed, but E-ICSI showed higher FR in a subgroup of men with oligozoospermia and no prior ICSI failures.

Conclusions:

• Utilizing testicular sperm in T-ICSI cycles improves pregnancy and live birth rates and reduces miscarriage rates for men with high SDF, oligozoospermia, or prior ICSI failures.
• Testicular sperm selection offers a strategy to mitigate sperm DNA damage.
• Further high-quality randomized controlled trials are needed due to the moderate to serious risk of bias in existing studies.