Table 1. Studies reporting ICSI outcomes with testicular versus ejaculated sperm in non-azoospermic men with high sperm DNA fragmentation in the neat semen.
| Study characteristics | Indication | Sperm retrieval method | Outcomes | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Author (year) | Design | Subjects and cohort size (N) | Test used for sperm
chromatin damage assessment and cutoff values (%) |
Paired SDF
results in testicular and ejaculated sperm (%) |
Sperm retrieval
method |
Sperm
retrieval success and complication rates (%) |
Fertilization
rate (%) |
Clinical
pregnancy rate (%) |
Ongoing
pregnancy rate or live birth rate a (%) |
| Greco
et al.
9
(2005) |
Case series | Predominantly normozoospermic
infertile men (18); couples with history of ICSI failure performed with ejaculated sperm |
TUNEL (15) | 23.6 ± 5.1 (E)
and 4.8 ± 3.6 (T) ( P <0.001) |
TESE and TESA | 100.0 and NR | 74.9 b | 44.4 c | NR |
| Sakkas and
Alvarez 19 (2010) |
Case series | Couples with history of IVF/ICSI
failure (68) with ejaculated sperm |
TUNEL (20) | NR | TESA | NR | 58.0; range:
20.0–100.0 |
40.0 | NR |
| Esteves
et al. 24 (2015) |
Prospective
cohort |
Oligozoospermic (sperm
concentration 5–15 million/mL) infertile men (172); couples with no history of ICSI failure (Testi-ICSI, n = 81 and Ejac-ICSI, n = 91) |
SCD (30) | 40.9 ± 10.2 (E)
and 8.3 ± 5.3 (T) ( P <0.001) |
TESE and TESA | 100.0 and 6.2 | 69.4 (E) vs.
56.1 (T) ( P = 0.0001) |
40.2 (E) vs. 51.9
(T) (NS) |
LBR: 26.4 (E)
vs. 46.7 (T) ( P = 0.007) |
| Mehta
et al.
25
(2015) |
Case series | Oligozoospermic (sperm
concentration <5 million/mL) infertile men (24); couples with one or more failed IVF or ICSI cycles using ejaculated sperm |
TUNEL (7) | 24.0 (95% CI
19–34) (E) and 5.0 (95% CI 3–7) (T) ( P = 0.001) |
Micro-TESE | 100.0 and NR | 54.0 | 50.0 | 50.0 |
| Bradley
et al. 27 (2016) |
Retrospective
cohort |
Predominantly oligozoospermic
infertile men; Testi-ICSI (n = 148) d, Ejac-ICSI (n = 80) d |
SCIT (29) | NR | TESE and TESA | NR | 66.0 (E) vs.
57.0 (T) ( P <0.001) |
27.5 (E) vs. 49.5
(T) ( P <0.01) |
LBR: 24.2 (E)
vs. 49.8 (T) ( P <0.05) |
| Pabuccu
et al. 28 (2016) |
Retrospective
cohort |
Normozoospermic infertile men (71);
couples with history of ICSI failure using ejaculated sperm (Testi-ICSI, n = 31; Ejac-ICSI, n = 40) |
TUNEL (30) | 41.7 ± 8.2 (E) | TESA | 100.0 and NR | 74.1 ± 20.7
(T) vs. 71.1 ± 26.9 (E) (NS) |
41.9 (T) vs. 20.0
(E) ( P = 0.04) |
OPR: 38.7 (T)
vs. 15.0 (E) ( P = 0.02) |
| Arafa
et al.
29
(2018) |
Prospective
cohort; interventions applied in the same patients |
Oligozoospermic and
normozoospermic infertile men (36); couples with history of ICSI failure performed with ejaculated sperm |
SCD (30) | 56.3 ± 15.3 (E) | TESA | 100.0 and
NR |
46.4 (T) vs.
47.8 (E) (NS) |
38.9 (T) vs. 13.8
(E) ( P <0.0001) |
LBR: 38.9 (T)
vs. 8.0 (E) ( P <0.0001) |
| Zhang
et al.
30
(2018) |
Prospective
cohort e |
Oligozoospermic and
normozoospermic infertile men (102); couples with no history of ICSI failure (Testi-ICSI, n = 61; Ejac-ICSI, n = 41) |
SCSA (30) | NR | TESA | 100.0 and
NR |
70.4 (T) vs.
75.0 (E) (NS) |
36.0 (T) vs. 14.6
(E) ( P = 0.01) |
LBR: 36.0 (T)
vs. 9.8 (E) ( P = 0.001) |
| Herrero
et al. 31 (2019) |
Retrospective
cohort |
Couples with no previous live births
and a history of at least two previous failed ICSI cycles with ejaculated sperm (Testi-ICSI, n = 77; Ejac-ICSI, n = 68) |
SCSA (25); TUNEL
(36%) |
NR | TESE | NR | SCSA: 66.3
(T); 62.9 (E) (NS) TUNEL: 61.2 (T); 57.6 (E) (NS) |
SCSA: 18.2
(T); 9.1% (E) ( P <0.02) TUNEL: 23.1 (T); 0.0 (E) ( P <0.02) |
fSCSA: 21.7
(T); 9.1 (E) ( P <0.01) TUNEL: 20.0 (T); 0.0 (E) ( P <0.02) |
| Alharbi
et al. 32 (2019) |
Retrospective
cohort |
Couples with one or more failed ICSI
cycles with ejaculated sperm Testi- ICSI, n = 52; Ejac-ICSI, n = 48) |
SCSA (15);
subgroup analysis using SCSA thresholds of 30% |
NR | TESA | 100.0 and
NR |
58.0 ± 27.0
(T) vs. 70.0 ± 23.0 ( P = 0.03) |
DFI >15%: 48.6
(T) vs. 38.7 (E); DFI >30%: 48.0% vs. 25.0% ( P = 0.25) |
gDFI >15%:
36.4 (T) vs. 30.0 (E); DFI >30%: 29.2 vs. 25.0 (NS) |
aHerrero et al. 31 reported cumulative live birth rates.
b2PN fertilization rate with use of testicular sperm; data from previous cycles with use of ejaculated sperm not provided.
cThe authors reported only one pregnancy with ejaculated sperm which miscarried.
dNumber of intracytoplasmic sperm injection (ICSI) cycles.
eInferred from the study’s reported data.
fCumulative live birth rates.
gAlharbi et al. 32 reported pregnancy rates per embryo transfer; live birth data were incomplete as a number of patients achieving clinical pregnancy were lost in follow-up. E, ejaculated sperm group; Ejac-ICSI, ICSI with ejaculated sperm; LBR, live birth rate; micro-TESE, microdissection testicular sperm extraction; NR, not reported; NS, not significantly different; OPR, ongoing pregnancy rate; SCD, sperm chromatin dispersion; SCIT, sperm chromatin integrity test, a variation of sperm chromatin structure assay (SCSA); SDF, sperm DNA fragmentation; T, testicular sperm group; TESA, testicular sperm aspiration; TESE, Testicular sperm extraction, Testi-ICSI, ICSI with testicular sperm; TUNEL, terminal deoxyribonucleotide transferase–mediated dUTP nick-end labeling assay.