Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
Eur Urol Focus. 2024 May;10(3):410-420. doi: 10.1016/j.euf.2023.08.008. Epub 2023 Sep 13.
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.
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.
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.
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.
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.
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.
对于精子 DNA 碎片化（SDF）升高的非无精子症不育男性，使用睾丸精子进行胞浆内单精子注射（ICSI）是否优于射出精子，目前尚不清楚。
确定对于 SDF 升高的男性，与射出精子相比，睾丸精子的 ICSI 结局（受精率、妊娠率、流产率和活产率）是否更好。
我们根据系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）声明，于 2023 年 2 月在 Cochrane 中央、EMBASE、MEDLINE、Web of Science 和 Scopus 数据库中检索了相关的人类对照研究。
在 2032 条记录中，纳入了 9 项研究（超过 536 名参与者，男性平均年龄范围为 33-40.5 岁，女性为 30.1-37.9 岁）进行系统评价和荟萃分析。汇总估计表明，根据精子染色质结构分析（SCSA）/精子染色质完整性试验（SCIT）和末端脱氧核苷酸转移酶 dUTP 末端标记（TUNEL）检测，睾丸精子的妊娠率显著高于射出精子（比值比 [OR] 2.51；p=0.001）和（OR 3.65；p=0.005）。根据 SCSA/SCIT，睾丸精子的活产率显著更高（OR 2.59；p=0.005）。受精率和流产率无显著差异。
尽管睾丸精子的使用在妊娠率和活产率方面有显著提高，但由于证据的可及性和质量有限，发现的强度受到限制，这两者都不利于为临床实践提供建议。需要进行标准化的随机对照试验来明确确定对于 SDF 较高的男性，使用睾丸精子是否能改善 ICSI 结局。在有这样的证据之前，不应该常规进行睾丸精子提取或抽吸后的 ICSI。
我们的综述表明，对于精子 DNA 损伤水平较高的不育男性，与射出精子相比，使用从睾丸提取的精子进行特定的体外受精（IVF）技术可能会获得更好的结果。然而，目前高质量数据的缺乏。
