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Implications of Sperm Source on ICSI Outcome: Assessment of TESE and Other Surgical Sperm Retrieval Methods

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Intracytoplasmic Sperm Injection

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Abstract

This chapter addresses the options for sperm origin for couples requiring intracytoplasmic sperm injection (ICSI) for advanced fertility treatment. Sperm from various sources have been shown to have differing properties, which are thought to affect ICSI outcomes. One of these key differences is in the DNA fragmentation index (DFI). It has been postulated that sperm DFI increases during transit through the male genital tract and that this may impact fertilization and pregnancy rates. Sperm may be either ejaculated or surgically retrieved from the testicle, vas deferens, or epididymis. Various retrieval methods exist. In men with azoospermia, epididymal and testicular sperm have been utilized for ICSI with varied results; therefore, a conclusive superior source cannot be identified. In men with cryptozoospermia, ejaculated sperm or surgically retrieved sperm can be used. Comparing testicular and ejaculated sperm, combining all studies no statistically significant difference in pregnancy or fertilization rates have been seen.

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Abbreviations

ART:

Assisted reproductive technology

CBAVD:

Congenital bilateral absence of the vas deferens

CI:

Confidence interval

DFI:

DNA fragmentation index

DNA:

Deoxyribonucleic acid

ICSI:

Intracytoplasmic sperm injection

IVF:

In vitro fertilization

MESA:

Micro-epididymal sperm aspiration

microTESE:

Microdissection testicular sperm extraction

PESA:

Percutaneous epididymal sperm aspiration

RR:

Relative risk

SSR:

Sperm retrieval rate

TESA:

Testicular sperm aspiration

TESE:

Testicular sperm extraction

TUNEL:

dUTP nick end labelling

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Authors and Affiliations

  1. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA

    Nikita Abhyankar & Samuel Ohlander

  2. Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Martin Kathrins

Authors
  1. Nikita Abhyankar
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  2. Samuel Ohlander
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  3. Martin Kathrins
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Correspondence to Nikita Abhyankar .

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Editors and Affiliations

  1. Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York, USA

    Gianpiero D. Palermo

  2. Center for Advanced Genetics, San Clemente, California, USA

    E. Scott Sills

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Abhyankar, N., Ohlander, S., Kathrins, M. (2018). Implications of Sperm Source on ICSI Outcome: Assessment of TESE and Other Surgical Sperm Retrieval Methods. In: Palermo, G., Sills, E. (eds) Intracytoplasmic Sperm Injection. Springer, Cham. https://doi.org/10.1007/978-3-319-70497-5_11

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