{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:08:39Z","timestamp":1793502519399,"version":"4.5.0"},"reference-count":69,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biology"],"abstract":"<jats:p>This study aimed to compare sperm DNA fragmentation (SDF) levels between ejaculate and testicular sperm and evaluate clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles using testicular sperm (T-ICSI) versus ejaculate sperm (E-ICSI) in males with high ejaculate SDF, prior ICSI failures, or severe male infertility. A systematic review of major databases and a subsequent meta-analysis were performed to compare clinical outcomes in men with high SDF, oligozoospermia, or prior ICSI failures undergoing T-ICSI or E-ICSI. Thirteen studies met the inclusion criteria. Outcomes analyzed included SDF levels, fertilization rate (FR), clinical pregnancy rate (CPR), live birth rate (LBR) per embryo transfer (ET), and miscarriage rate (MR) per pregnancy. The mean difference (MD) and odds ratio (OR) were calculated for each outcome. Paired assessments of SDF showed significantly lower levels in testicular sperm compared to ejaculated sperm (MD = \u221225.42 [\u221231.47, \u221217.30], p &lt; 0.00001). While no significant difference in FR was observed in T-ICSI cycles overall (OR = 0.94 [0.74, 1.20]), a subgroup analysis revealed significantly higher FR with E-ICSI in men with oligozoospermia and no prior ICSI failures (OR = 0.61 [0.52, 0.71], p &lt; 0.00001). CPR was significantly higher in T-ICSI cycles (OR = 2.13 [1.35, 3.36], p &lt; 0.001; n = 540 ET), along with a significantly lower MR (OR = 0.31 [0.14, 0.70], p = 0.004; n = 35) and increased LBR (OR = 2.40 [1.32, 4.36], p = 0.004; n = 446 ET). In conclusion, using testicular sperm in cases of elevated ejaculate SDF, oligozoospermia, or prior failed ICSI cycles enhances the selection of sperm with lower DNA damage, leading to improved pregnancy rates, reduced miscarriage rates, and higher live birth rates. However, the studies included were rated as having a moderate to serious risk of bias. Further well-designed randomized controlled trials are necessary to confirm these findings with stronger evidence.<\/jats:p>","DOI":"10.3390\/biology14020130","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T04:59:10Z","timestamp":1737953950000},"page":"130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Superior Live Birth Rates, Reducing Sperm DNA Fragmentation (SDF), and Lowering Miscarriage Rates by Using Testicular Sperm Versus Ejaculates in Intracytoplasmic Sperm Injection (ICSI) Cycles from Couples with High SDF: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Marina","family":"Cano-Extremera","sequence":"first","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Hervas","sequence":"additional","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alma","family":"Gisbert Iranzo","sequence":"additional","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar","family":"Falquet Guillem","sequence":"additional","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6863-8981","authenticated-orcid":false,"given":"Mar\u00eda","family":"Gil Juli\u00e1","sequence":"additional","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1687-1279","authenticated-orcid":false,"given":"Ana","family":"Navarro-Gomezlechon","sequence":"additional","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Pacheco-Rend\u00f3n","sequence":"additional","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8271-5218","authenticated-orcid":false,"given":"Nicol\u00e1s","family":"Garrido Puchalt","sequence":"additional","affiliation":[{"name":"IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106\u2014Torre A, Planta 1\u00aa, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021). WHO Laboratory Manual for the Examination and Processing of Human Semen Sixth Edition, WHO."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.fertnstert.2021.05.087","article-title":"Testicular Sperm Extraction vs. Ejaculated Sperm Use for Nonazoospermic Male Factor Infertility","volume":"116","author":"Kim","year":"2021","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/0140-6736(92)92425-F","article-title":"Pregnancies after Intracytoplasmic Injection of Single Spermatozoon into an Oocyte","volume":"340","author":"Palermo","year":"1992","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.fertnstert.2009.10.046","article-title":"Sperm DNA Fragmentation: Mechanisms of Origin, Impact on Reproductive Outcome, and Analysis","volume":"93","author":"Sakkas","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ribas-Maynou, J., and Benet, J. (2019). Single and Double Strand Sperm DNA Damage: Different Reproductive Effects on Male Fertility. Genes, 10.","DOI":"10.3390\/genes10020105"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1111\/brv.12700","article-title":"Clinical Implications of Sperm DNA Damage in IVF and ICSI: Updated Systematic Review and Meta-Analysis","volume":"96","author":"Yeste","year":"2021","journal-title":"Biol. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.fertnstert.2019.03.003","article-title":"Sperm DNA Fragmentation and Recurrent Pregnancy Loss: A Systematic Review and Meta-Analysis","volume":"112","author":"McQueen","year":"2019","journal-title":"Fertil. Steril."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"80","DOI":"10.4103\/1008-682X.182822","article-title":"A Systematic Review and Meta-Analysis to Determine the Effect of Sperm DNA Damage on in Vitro Fertilization and Intracytoplasmic Sperm Injection Outcome","volume":"19","author":"Simon","year":"2017","journal-title":"Asian J. Androl."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/GCO.0000000000000271","article-title":"Should We Evaluate and Treat Sperm DNA Fragmentation?","volume":"28","author":"Agarwal","year":"2016","journal-title":"Curr. Opin. Obs. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.fertnstert.2013.03.011","article-title":"In Vitro Fertilization-Intracytoplasmic Sperm Injection Outcome in Patients with a Markedly High DNA Fragmentation Index (>50%)","volume":"100","author":"Dar","year":"2013","journal-title":"Fertil. Steril."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Okubo, T., Onda, N., Hayashi, T., Kobayashi, T., Omi, K., and Segawa, T. (2023). Performing a Sperm DNA Fragmentation Test in Addition to Semen Examination Based on the WHO Criteria Can Be a More Accurate Diagnosis of IVF Outcomes. BMC Urol., 23.","DOI":"10.1186\/s12894-023-01257-y"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"412","DOI":"10.5534\/wjmh.200128","article-title":"Sperm DNA Fragmentation: A New Guideline for Clinicians","volume":"38","author":"Agarwal","year":"2020","journal-title":"World J. Men\u2019s Health"},{"key":"ref_13","first-page":"e13874","article-title":"Sperm DNA Fragmentation Testing: Summary Evidence and Clinical Practice Recommendations","volume":"53","author":"Esteves","year":"2020","journal-title":"Andrologia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/humrep\/deh590","article-title":"Efficient Treatment of Infertility Due to Sperm DNA Damage by ICSI with Testicular Spermatozoa","volume":"20","author":"Greco","year":"2005","journal-title":"Hum. Reprod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.fertnstert.2008.11.005","article-title":"Testicular Spermatozoa Have Statistically Significantly Lower DNA Damage Compared with Ejaculated Spermatozoa in Patients with Unsuccessful Oral Antioxidant Treatment","volume":"93","author":"Moskovtsev","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"142","DOI":"10.3109\/19396368.2012.667504","article-title":"A Comparison of Ejaculated and Testicular Spermatozoa Aneuploidy Rates in Patients with High Sperm DNA Damage","volume":"58","author":"Moskovtsev","year":"2012","journal-title":"Syst. Biol. Reprod. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/j.fertnstert.2015.08.008","article-title":"Higher Pregnancy Rates Using Testicular Sperm in Men with Severe Oligospermia","volume":"104","author":"Mehta","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1016\/j.fertnstert.2015.08.028","article-title":"Comparison of Reproductive Outcome in Oligozoospermic Men with High Sperm DNA Fragmentation Undergoing Intracytoplasmic Sperm Injection with Ejaculated and Testicular Sperm","volume":"104","author":"Esteves","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e12609","DOI":"10.1111\/and.12609","article-title":"Testicular versus Ejaculated Spermatozoa in ICSI Cycles of Normozoospermic Men with High Sperm DNA Fragmentation and Previous ART Failures","volume":"49","author":"Pabuccu","year":"2017","journal-title":"Andrologia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1111\/andr.12215","article-title":"Intervention Improves Assisted Conception Intracytoplasmic Sperm Injection Outcomes for Patients with High Levels of Sperm DNA Fragmentation: A Retrospective Analysis","volume":"4","author":"Bradley","year":"2016","journal-title":"Andrology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e12835","DOI":"10.1111\/and.12835","article-title":"ICSI Outcome in Patients with High DNA Fragmentation: Testicular versus Ejaculated Spermatozoa","volume":"50","author":"Arafa","year":"2018","journal-title":"Andrologia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/andr.12591","article-title":"ICSI Outcomes Using Testicular Spermatozoa in Non-Azoospermic Couples with Recurrent ICSI Failure and No Previous Live Births","volume":"7","author":"Herrero","year":"2019","journal-title":"Andrology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E272","DOI":"10.5489\/cuaj.6798","article-title":"Sperm Retrieval and Intracytoplasmic Sperm Injection Outcomes with Testicular Sperm Aspiration in Men with Severe Oligozoospermia and Cryptozoospermia","volume":"15","author":"Alharbi","year":"2020","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3101","DOI":"10.1093\/humrep\/dei169","article-title":"Decline in Fertility of Mouse Sperm with Abnormal Chromatin during Epididymal Passage as Revealed by ICSI","volume":"20","author":"Suganuma","year":"2005","journal-title":"Hum. Reprod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1097\/JU.0000000000000659","article-title":"Sperm Genomic Integrity by TUNEL Varies throughout the Male Genital Tract","volume":"203","author":"Xie","year":"2020","journal-title":"J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.21037\/tau-23-415","article-title":"Outcomes Comparison of Testicular versus Ejaculated Sperm for Intracytoplasmic Sperm Injection in Infertile Men with High DNA Fragmentation: Updated Systematic Review and Meta-Analysis","volume":"12","author":"Zhao","year":"2023","journal-title":"Transl. Androl. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.fertnstert.2017.06.018","article-title":"Reproductive Outcomes of Testicular versus Ejaculated Sperm for Intracytoplasmic Sperm Injection among Men with High Levels of DNA Fragmentation in Semen: Systematic Review and Meta-Analysis","volume":"108","author":"Esteves","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"348","DOI":"10.4103\/aja.aja_99_19","article-title":"Use of Testicular Sperm in Couples with SCSA- Defined High Sperm DNA Fragmentation and Failed Intracytoplasmic Sperm Injection Using Ejaculated Sperm","volume":"22","author":"Alharbi","year":"2020","journal-title":"Asian J. Androl."},{"key":"ref_29","first-page":"44","article-title":"Reproductive Outcomes of Testicular and Ejaculated Sperm for ICSI in Patients with Previous ICSI Failures: A Systematic Review and Meta-Analysis","volume":"17","author":"Yu","year":"2021","journal-title":"J. Men\u2019s Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.euf.2023.08.008","article-title":"Does Testicular Sperm Improve Intracytoplasmic Sperm Injection Outcomes for Nonazoospermic Infertile Men with Elevated Sperm DNA Fragmentation? A Systematic Review and Meta-Analysis","volume":"10","author":"Khoo","year":"2024","journal-title":"Eur. Urol. Focus"},{"key":"ref_31","unstructured":"Herrero, I.H. (2024). Evaluaci\u00f3n de La Mejora En Los Resultados Cl\u00ednicos En Varones Con Oligozoospermia Severa, Fallos de ICSI y Elevada Fragmentaci\u00f3n Del ADN Mediante El Uso de Espermatozoides Testiculares. [Ph.D. Thesis, Facultat de Ci\u00e8ncies Biol\u00f2giques]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2338290","DOI":"10.1080\/14647273.2024.2338290","article-title":"Reproductive Outcomes in Patients with High Levels of Sperm DNA Fragmentation Using Testicular Sperm for Intracytoplasmic Injection: A Retrospective Analysis","volume":"27","author":"Zhou","year":"2024","journal-title":"Hum. Fertil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.fertnstert.2013.09.002","article-title":"Diagnostic Accuracy of Sperm Chromatin Dispersion Test to Evaluate Sperm Deoxyribonucleic Acid Damage in Men with Unexplained Infertility","volume":"101","author":"Esteves","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S0015-0282(02)03219-3","article-title":"Increased Sperm Nuclear DNA Damage in Normozoospermic Infertile Men: A Prospective Study","volume":"78","author":"Saleh","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.rbmo.2014.10.018","article-title":"The Effect of Sperm DNA Fragmentation on Live Birth Rate after IVF or ICSI: A Systematic Review and Meta-Analysis","volume":"30","author":"Osman","year":"2015","journal-title":"Reprod. Biomed. Online"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.fertnstert.2022.04.002","article-title":"Sperm Deoxyribonucleic Acid Fragmentation (by Terminal Deoxynucleotidyl Transferase Biotin DUTP Nick End Labeling Assay) Does Not Impair Reproductive Success Measured as Cumulative Live Birth Rates per Donor Metaphase II Oocyte Used","volume":"118","author":"Pacheco","year":"2022","journal-title":"Fertil. Steril."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.rbmo.2022.02.010","article-title":"IVF\/ICSI Cumulative Live Birth Rates per Consumed Oocyte Remain Comparable Regardless of Sperm DNA Fragmentation by TUNEL","volume":"44","author":"Hervas","year":"2022","journal-title":"Reprod. Biomed. Online"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1080\/14647273.2021.1877364","article-title":"Sperm DNA Fragmentation on the Day of Fertilisation Is Not Associated with Assisted Reproductive Technique Outcome Independently of Gamete Quality","volume":"25","author":"Ten","year":"2021","journal-title":"Hum. Fertil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s10815-019-01632-5","article-title":"Sperm DNA Fragmentation on the Day of Fertilization Is Not Associated with Embryologic or Clinical Outcomes after IVF\/ICSI","volume":"37","author":"Green","year":"2020","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1093\/humrep\/dez308","article-title":"Female Ageing Affects the DNA Repair Capacity of Oocytes in IVF Using a Controlled Model of Sperm DNA Damage in Mice","volume":"35","author":"Horta","year":"2020","journal-title":"Hum. Reprod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.fertnstert.2020.10.045","article-title":"Oocyte Ability to Repair Sperm DNA Fragmentation: The Impact of Maternal Age on Intracytoplasmic Sperm Injection Outcomes","volume":"116","author":"Setti","year":"2021","journal-title":"Fertil. Steril."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.fertnstert.2010.05.055","article-title":"Effect of Sperm DNA Fragmentation on Pregnancy Outcome Depends on Oocyte Quality","volume":"95","author":"Meseguer","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1111\/andr.13405","article-title":"Surgically Retrieved Spermatozoa for ICSI Cycles in Non-Azoospermic Males with High Sperm DNA Fragmentation in Semen","volume":"11","author":"Esteves","year":"2023","journal-title":"Andrology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"566","DOI":"10.2164\/jandrol.109.008912","article-title":"Spermatozoa Bound to Solid State Hyaluronic Acid Show Chromatin Structure with High DNA Chain Integrity: An Acridine Orange Fluorescence Study","volume":"31","author":"Yagci","year":"2010","journal-title":"J. Androl."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1111\/andr.13362","article-title":"Can a Sperm Selection Technique Improve Embryo Ploidy?","volume":"11","author":"Kocur","year":"2023","journal-title":"Andrology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.rbmo.2017.01.015","article-title":"Magnetic Cell Sorting of Semen Containing Spermatozoa with High DNA Fragmentation in ICSI Cycles Decreases Miscarriage Rate","volume":"34","author":"Johnston","year":"2017","journal-title":"Reprod. Biomed. Online"},{"key":"ref_47","first-page":"2555","article-title":"Association between Early Embryo Morphokinetics plus Transcript Levels of Sperm Apoptotic Genes and Clinical Outcomes in IMSI and ICSI Cycles of Male Factor Patients","volume":"37","author":"Mangoli","year":"2020","journal-title":"Reprod. Physiol. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.urology.2016.03.059","article-title":"Abstinence Time and Its Impact on Basic and Advanced Semen Parameters","volume":"94","author":"Agarwal","year":"2016","journal-title":"Urology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1038\/s41585-021-00472-2","article-title":"Advances in Sperm Analysis: Techniques, Discoveries and Applications","volume":"18","author":"Dai","year":"2021","journal-title":"Nat. Rev. Urol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S0140-6736(18)32989-1","article-title":"Physiological, Hyaluronan-Selected Intracytoplasmic Sperm Injection for Infertility Treatment (HABSelect): A Parallel, Two-Group, Randomised Trial","volume":"393","author":"Miller","year":"2019","journal-title":"Lancet"},{"key":"ref_51","first-page":"CD010461","article-title":"Advanced Sperm Selection Techniques for Assisted Reproduction","volume":"7","author":"Lepine","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e13175","DOI":"10.1111\/and.13175","article-title":"Testicular Spermatozoon Is Superior to Ejaculated Spermatozoon for Intracytoplasmic Sperm Injection to Achieve Pregnancy in Infertile Males with High Sperm DNA Damage","volume":"51","author":"Zhang","year":"2019","journal-title":"Andrologia"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Hozain, M., Alkhader, H., Eltanbouly, S., and Zaki, H. (2018, January 1\u20134). A Comparison of Reproductive Outcome Using Testicular Sperm Vs. Ejaculated Sperm in ICSI for Patients with Abnormal DNA Fragmentation. Proceedings of the Abstracts of the 34th Annual Meeting of ESHRE, Barcelona, Spain.","DOI":"10.26226\/morressier.5af300ad738ab10027aa91f9"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/j.fertnstert.2016.02.013","article-title":"Use of Testicular versus Ejaculated Sperm for Intracytoplasmic Sperm Injection among Men with Cryptozoospermia: A Meta-Analysis","volume":"105","author":"Abhyankar","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/andr.12317","article-title":"Testicular Sperm Aspiration (TESA) for Infertile Couples with Severe or Complete Asthenozoospermia","volume":"5","author":"Alrabeeah","year":"2017","journal-title":"Andrology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1016\/j.fertnstert.2013.02.025","article-title":"Intracytoplasmic Sperm Injection Outcome of Ejaculated versus Extracted Testicular Spermatozoa in Cryptozoospermic Men","volume":"99","author":"Raziel","year":"2013","journal-title":"Fertil. Steril."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S1472-6483(10)60306-9","article-title":"Pregnancies and Live Births Following ICSI with Testicular Spermatozoa after Repeated Implantation Failure Using Ejaculated Spermatozoa","volume":"17","author":"Weissman","year":"2008","journal-title":"Reprod. Biomed. Online"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/humupd\/dmad006","article-title":"Contribution of Semen to Early Embryo Development: Fertilization and Beyond","volume":"29","author":"Mecca","year":"2023","journal-title":"Hum. Reprod. Update"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1023\/A:1022537117578","article-title":"In Vitro Fertilization Treatment for Severe Male Factor: A Comparative Study of Intracytoplasmic Sperm Injection with Testicular Sperm Extraction and with Spermatozoa from Ejaculate","volume":"15","author":"Hourvitz","year":"1998","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1007\/s10815-018-1191-8","article-title":"Potential of Testicular Sperm to Support Embryonic Development to the Blastocyst Stage Is Comparable to That of Ejaculated Sperm","volume":"35","author":"Lee","year":"2018","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"103","DOI":"10.3109\/09513590.2013.850589","article-title":"Pregnancy Outcome after ICSI with Thawed Testicular Sperm from Men with Non-Obstructive Azoospermia Compared to ICSI with Ejaculated Sperm from Men with Severe Oligoasthenoteratozoospermia and IVF with Normal Ejaculated Sperm","volume":"30","author":"Oron","year":"2014","journal-title":"Gynecol. Endocrinol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"eaaz7602","DOI":"10.1126\/sciadv.aaz7602","article-title":"Sperm DNA Damage Causes Genomic Instability in Early Embryonic Development","volume":"6","author":"Middelkamp","year":"2020","journal-title":"Sci. Adv."},{"key":"ref_63","first-page":"e13718","article-title":"Comparative Analysis of Tests Used to Assess Sperm Chromatin Integrity and DNA Fragmentation","volume":"53","author":"Dutta","year":"2020","journal-title":"Andrologia"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.fertnstert.2014.06.033","article-title":"Whether Sperm Deoxyribonucleic Acid Fragmentation Has an Effect on Pregnancy and Miscarriage after in Vitro Fertilization\/Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis","volume":"102","author":"Zhao","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2164\/jandrol.106.000067","article-title":"Increased Aneuploidy Rate in Sperm with Fragmented DNA as Determined by the Sperm Chromatin Dispersion (SCD) Test and FISH Analysis","volume":"28","author":"Muriel","year":"2007","journal-title":"J. Androl."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.rbmo.2013.12.001","article-title":"Correlation between Aneuploidy, Apoptotic Markers and DNA Fragmentation in Spermatozoa from Normozoospermic Patients","volume":"28","author":"Vendrell","year":"2014","journal-title":"Reprod. Biomed. Online"},{"key":"ref_67","unstructured":"Figueira, R.C.J., Bento, F.C., Melo, A.A., Martinhago, C.D., and Esteves, S.C. (2019, January 25). ICSI Using Surgically Retrieved Testicular Sperm Of-Azoospermic Men with High Sperm DNA Fragmentation and Blastocyst Ploidy: A Safe Approachhuman Reproduction. Proceedings of the Abstracts of the 35th Annual Meeting of the European Society of Human Reproduction and Embryology, Vienna, Austria."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1007\/s10815-022-02595-w","article-title":"Switching to Testicular Sperm after a Previous ICSI Failure with Ejaculated Sperm Significantly Improves Blastocyst Quality without Increasing Aneuploidy Risk","volume":"39","author":"Hervas","year":"2022","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/aja.aja_7_17","article-title":"Use of Testicular Sperm for Intracytoplasmic Sperm Injection in Men with High Sperm DNA Fragmentation: A SWOT Analysis","volume":"20","author":"Esteves","year":"2018","journal-title":"Asian J. Androl."}],"container-title":["Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-7737\/14\/2\/130\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:36:47Z","timestamp":1759919807000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-7737\/14\/2\/130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,26]]},"references-count":69,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["biology14020130"],"URL":"https:\/\/doi.org\/10.3390\/biology14020130","relation":{},"ISSN":["2079-7737"],"issn-type":[{"value":"2079-7737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,26]]}}}