World J Mens Health.  2021 Jul;39(3):391-398. 10.5534/wjmh.200084.

The Use of Testicular Sperm for Intracytoplasmic Sperm Injection in Patients with High Sperm DNA Damage: A Systematic Review

  • 1American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
  • 2Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
  • 3Hope Clinic–Human Reproduction, São Paulo, Brazil
  • 4Department of Urology, Hamad Medical Corporation, Qatar
  • 5Weill Cornell Medicine-Qatar, Doha, Qatar
  • 6Department of Urology, Cleveland Clinic, Cleveland, OH, USA
  • 7Division of Urology, Southern Illinois University, Springfield, IL, USA
  • 8Department of Surgery, Union Hospital, Hong Kong
  • 9S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
  • 10Fertility Medical Group, Sapientiae Institute, São Paulo, Brazil
  • 11Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil


The advent of intracytoplasmic sperm injection (ICSI) has changed the human reproduction landscape by overcoming several limitations related to both male and female infertility factors. However, despite the development of new technologies, the live-birth rate with ICSI has not exceeded 30%. In order to improve assisted reproductive technology outcomes, advanced sperm function analysis have gained increased attention and the effects of sperm DNA fragmentation (SDF) on assisted reproduction success are being extensively studied. Utilizing ejaculated sperm with an elevated SDF has been found to result in poor ICSI outcomes. Furthermore, studies have reported that testicular sperm has lower SDF level, when compared to ejaculated sperm. This has led a number of clinicians world-wide to offer testicular sperm retrieval for ICSI in non-azoospermic males with high SDF. This practice has remained controversial due to lack of high quality evidence.


DNA damage; DNA fragmentation; Infertility; male; Sperm retrieval
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