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

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.