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The primary indications include high levels\u00a0of\u00a0sperm DNA damage in ejaculated spermatozoa and severe oligozoospermia or cryptozoospermia, particularly in couples with ICSI failure\u00a0for no apparent reason. Current evidence suggests that surgically retrieved spermatozoa for ICSI in the above context improves \u00a0outcomes, mainly concerning pregnancy and miscarriage rates. The reasons are not fully understood but may be related to the lower levels of DNA damage in spermatozoa retrieved from the testis compared with ejaculated counterparts. These findings are consistent with the notion that excessive sperm DNA damage \u00a0can be a limiting factor responsible for the failure to conceive. Using testicular in preference of low\u2010quality ejaculated spermatozoa bypasses post\u2010testicular sperm DNA damage caused primarily by oxidative stress, thus\u00a0increasing the likelihood of oocyte fertilization by genomically intact spermatozoa. Despite the overall favorable results, data remain limited, and\u00a0mainly concern males with confirmed sperm DNA damage in the ejaculate. Additionally, information regarding the health of ICSI offspring resulting from the\u00a0use\u00a0of\u00a0surgically\u00a0retrieved\u00a0spermatoa\u00a0of\u00a0non\u2010azoospermic\u00a0males is still lacking. Efforts should be made to improve the male partner's reproductive health for safer ICSI utilization. A comprehensive andrological evaluation aiming to identify and treat the underlying male infertility factor contributing to sperm DNA damage is essential for achieving this goal.<\/jats:p><\/jats:sec>","DOI":"10.1111\/andr.13405","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T10:38:55Z","timestamp":1675420735000},"page":"1613-1634","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Surgically retrieved spermatozoa for ICSI cycles in non\u2010azoospermic males with high sperm DNA fragmentation in semen"],"prefix":"10.1111","volume":"11","author":[{"given":"Sandro C.","family":"Esteves","sequence":"first","affiliation":[{"name":"ANDROFERT, Andrology and Human Reproduction Clinic Av. Dr. Heitor Penteado  Campinas SP Brazil"},{"name":"Department of Surgery (Division of Urology), Faculty of Medical Sciences University of Campinas (UNICAMP)  Campinas SP Brazil"},{"name":"Department of Clinical Medicine, Faculty of Health Aarhus University  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Coimbra","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Urology University of S\u00e3o Paulo Medical School  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Hallak","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Urology University of S\u00e3o Paulo Medical School  S\u00e3o Paulo SP Brazil"},{"name":"Department of Pathology, Reproductive Toxicology Unit University of S\u00e3o Paulo Medical School  S\u00e3o Paulo SP Brazil"},{"name":"Men's Health Study Group, Institute for Advanced Studies University of S\u00e3o Paulo  S\u00e3o Paulo SP Brazil"},{"name":"Androscience Science and Innovation Center in Andrology and High\u2010Complex Clinical and Andrology Research Laboratory  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deab152"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41585\u2010018\u20100051\u20108"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00099"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmh004"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-32300-4_28"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1590\/s1677\u201055382011000500002"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.23736\/s0031\u20100808.18.03508\u20105"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0015\u20100282(16)57486\u2010x"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/del130"},{"key":"e_1_2_16_11_1","doi-asserted-by":"publisher","DOI":"10.1023\/a:1009413201849"},{"key":"e_1_2_16_12_1","doi-asserted-by":"publisher","DOI":"10.1590\/s1677\u201055382008000100008"},{"key":"e_1_2_16_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh590"},{"key":"e_1_2_16_14_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.20564.1"},{"key":"e_1_2_16_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrg1654"},{"key":"e_1_2_16_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/432048a"},{"key":"e_1_2_16_17_1","doi-asserted-by":"publisher","DOI":"10.23736\/s2724\u2010606x.22.05169\u20107"},{"key":"e_1_2_16_18_1","doi-asserted-by":"publisher","DOI":"10.4103\/1008\u2010682x.170441"},{"key":"e_1_2_16_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2012.197"},{"key":"e_1_2_16_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255\u2010015\u20101053\u20106"},{"key":"e_1_2_16_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2021.11.026"},{"key":"e_1_2_16_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2006.06.023"},{"key":"e_1_2_16_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/aja.aja_7_17"},{"issue":"2","key":"e_1_2_16_24_1","first-page":"109","article-title":"Chromatin 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