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Hum. Reprod. Advance Access published online on November 11, 2004
Human Reproduction, doi:10.1093/humrep/deh590
© 2004 by European Society of Human Reproduction and Embryology
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Received June 21, 2004
Revised August 18, 2004
Accepted October 4, 2004

Article

Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular spermatozoa

Ermanno Greco 1, Filomena Scarselli 1, Marcello Iacobelli 1, Laura Rienzi 1, Filippo Ubaldi 1, Susanna Ferrero 1, Giorgio Franco 1, Nazareno Anniballo 1, Carmen Mendoza 2, and Jan Tesarik 3*

1 Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149 Rome, Italy
2 MAR&Gen, Molecular Assisted Reproduction and Genetics, Gracia 36, 18002 Granada, Spain; University of Granada, Campus Fuentenueva, 18004 Granada, Spain
3 MAR&Gen, Molecular Assisted Reproduction and Genetics, Gracia 36, 18002 Granada, Spain; Laboratoire d'Eylau, 55 rue Saint-Didier, 75116 Paris, France

* To whom correspondence should be addressed.
Jan Tesarik, E-mail: cmendoza{at}ugr.es


  Abstract

BACKGROUND: Sperm DNA damage (fragmentation) is a recently discovered cause of male infertility for which no efficient treatment has yet been found. Previous findings have suggested that clinically relevant sperm DNA damage may occur at the post-testicular level. This study was undertaken to assess the clinical usefulness of ICSI with testicular spermatozoa in this indication. METHODS: The percentage of spermatozoa with fragmented DNA, assessed by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labelling assay, and ICSI outcomes were compared in two sequential attempts performed, respectively, with ejaculated and testicular spermatozoa in 18 men with increased sperm DNA fragmentation. RESULTS: The incidence of DNA fragmentation was markedly lower in testicular spermatozoa as compared with ejaculated spermatozoa. No differences in fertilization and cleavage rates and in embryo morphological grade were found between the ICSI attempts performed with ejaculated and with testicular spermatozoa. However, eight ongoing clinical pregnancies (four singleton and four twin) were achieved by ICSI with testicular spermatozoa (44.4% pregnancy rate; 20.7% implantation rate), whereas ICSI with ejaculated spermatozoa led to only one pregnancy which was spontaneously aborted. CONCLUSIONS: These data show that ICSI with testicular spermatozoa provides the first efficient assisted reproduction treatment option for men with high levels of sperm DNA damage.

Keywords: DNA fragmentation; ejaculated spermatozoa; ICSI; sperm fertilizing ability; testicular spermatozoa.
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