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Does Testicular Sperm Improve Intracytoplasmic Sperm Injection Outcomes for Nonazoospermic Infertile Men with Elevated Sperm DNA Fragmentation? A Systematic Review and Meta-analysis

Khoo, Christopher C. ; Cayetano-Alcaraz, Axel Alberto ; Rashid, Razi ; Tharakan, Tharu ; Yap, Tet ; Sofikitis, Nikolaos ; Salonia, Andrea ; Corona, Giovanni ; Giwercman, Aleksander LU and Jayasena, Channa N. , et al. (2023) In European Urology Focus
Abstract

Context: For nonazoospermic infertile men with elevated sperm DNA fragmentation (SDF), it is unclear whether the use of testicular sperm for intracytoplasmic sperm injection (ICSI) may offer advantages over ejaculated sperm. Objective: To determine whether ICSI outcomes (fertilisation rate, pregnancy rate, miscarriage rate, and live birth rate) are better with testicular sperm than with ejaculated sperm for men with elevated SDF. Evidence acquisition: We searched the Cochrane Central, EMBASE, MEDLINE, Web of Science, and Scopus databases (1946–2023) in February 2023 for relevant human comparative studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Evidence synthesis: Out of... (More)

Context: For nonazoospermic infertile men with elevated sperm DNA fragmentation (SDF), it is unclear whether the use of testicular sperm for intracytoplasmic sperm injection (ICSI) may offer advantages over ejaculated sperm. Objective: To determine whether ICSI outcomes (fertilisation rate, pregnancy rate, miscarriage rate, and live birth rate) are better with testicular sperm than with ejaculated sperm for men with elevated SDF. Evidence acquisition: We searched the Cochrane Central, EMBASE, MEDLINE, Web of Science, and Scopus databases (1946–2023) in February 2023 for relevant human comparative studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Evidence synthesis: Out of 2032 records, nine studies (more than 536 participants, mean age range 33–40.5 yr for males and 30.1–37.9 yr for females) were included in the systematic review and meta-analysis. Pooled estimates demonstrated that the pregnancy rate was significantly higher with testicular than with ejaculated sperm according to a sperm chromatin structure assay (SCSA)/sperm chromatin integrity test (SCIT) (odds ratio [OR] 2.51; p = 0.001) and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) assays (OR 3.65; p = 0.005). The live birth rate was significantly higher according to SCSA/SCIT (OR 2.59; p = 0.005). There were no significant differences in the fertilisation rate or miscarriage rate. Conclusions: Although significant improvements in pregnancy and live birth rates were observed with testicular sperm, the strength of findings is limited by availability and quality of evidence, both of which undermine recommendations for clinical practice. Standardised randomised controlled trials are needed to definitively determine whether the use of testicular sperm improves ISCI outcomes for men with high SDF. Until such evidence exists, ICSI after testicular sperm extraction or aspiration should not be routinely performed. Patient summary: Our review showed that for infertile men with a high level of DNA damage in their sperm, use of sperm extracted from the testicles may give better results than ejaculated sperm for a particular IVF (in vitro fertilisation) technique. However, there is a lack of high-quality data.

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publication status
epub
subject
keywords
Assisted reproductive technology, Infertility, Intracytoplasmic sperm injection, Sperm DNA fragmentation
in
European Urology Focus
publisher
Elsevier
external identifiers
  • pmid:37709593
  • scopus:85171349355
ISSN
2405-4569
DOI
10.1016/j.euf.2023.08.008
language
English
LU publication?
yes
id
5e0ea2a2-9916-4a16-82ed-845932beb74c
date added to LUP
2023-12-28 12:18:23
date last changed
2024-04-12 17:21:02
@article{5e0ea2a2-9916-4a16-82ed-845932beb74c,
  abstract     = {{<p>Context: For nonazoospermic infertile men with elevated sperm DNA fragmentation (SDF), it is unclear whether the use of testicular sperm for intracytoplasmic sperm injection (ICSI) may offer advantages over ejaculated sperm. Objective: To determine whether ICSI outcomes (fertilisation rate, pregnancy rate, miscarriage rate, and live birth rate) are better with testicular sperm than with ejaculated sperm for men with elevated SDF. Evidence acquisition: We searched the Cochrane Central, EMBASE, MEDLINE, Web of Science, and Scopus databases (1946–2023) in February 2023 for relevant human comparative studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Evidence synthesis: Out of 2032 records, nine studies (more than 536 participants, mean age range 33–40.5 yr for males and 30.1–37.9 yr for females) were included in the systematic review and meta-analysis. Pooled estimates demonstrated that the pregnancy rate was significantly higher with testicular than with ejaculated sperm according to a sperm chromatin structure assay (SCSA)/sperm chromatin integrity test (SCIT) (odds ratio [OR] 2.51; p = 0.001) and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) assays (OR 3.65; p = 0.005). The live birth rate was significantly higher according to SCSA/SCIT (OR 2.59; p = 0.005). There were no significant differences in the fertilisation rate or miscarriage rate. Conclusions: Although significant improvements in pregnancy and live birth rates were observed with testicular sperm, the strength of findings is limited by availability and quality of evidence, both of which undermine recommendations for clinical practice. Standardised randomised controlled trials are needed to definitively determine whether the use of testicular sperm improves ISCI outcomes for men with high SDF. Until such evidence exists, ICSI after testicular sperm extraction or aspiration should not be routinely performed. Patient summary: Our review showed that for infertile men with a high level of DNA damage in their sperm, use of sperm extracted from the testicles may give better results than ejaculated sperm for a particular IVF (in vitro fertilisation) technique. However, there is a lack of high-quality data.</p>}},
  author       = {{Khoo, Christopher C. and Cayetano-Alcaraz, Axel Alberto and Rashid, Razi and Tharakan, Tharu and Yap, Tet and Sofikitis, Nikolaos and Salonia, Andrea and Corona, Giovanni and Giwercman, Aleksander and Jayasena, Channa N. and Minhas, Suks}},
  issn         = {{2405-4569}},
  keywords     = {{Assisted reproductive technology; Infertility; Intracytoplasmic sperm injection; Sperm DNA fragmentation}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{European Urology Focus}},
  title        = {{Does Testicular Sperm Improve Intracytoplasmic Sperm Injection Outcomes for Nonazoospermic Infertile Men with Elevated Sperm DNA Fragmentation? A Systematic Review and Meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.euf.2023.08.008}},
  doi          = {{10.1016/j.euf.2023.08.008}},
  year         = {{2023}},
}