Vol. 44 (4): 676-679, July – August, 2018
doi: 10.1590/S1677-5538.IBJU.2018.04.04
DIFFERENCE OF OPINION
Mark Sigman 1
1 Department of Urology Brown University and The Miriam Hospitals, RI 02906, EUA
Keywords: Semen; Infertility, Male; Sperm Injections, Intracytoplasmic; Sperm DNA Fragmenttion; Testicular Sperm
The argument for the use of testicular sperm instead of ejaculated sperm for infertility due to sperm DNA fragmentation (SDF) relies on several assumptions. When each assumption is examined, it becomes clear that the assumptions are either unproven, due to insufficient data, or just plain wrong. These assumptions are: 1) sperm DNA fragmentation assays are good diagnostic tests; 2) IVF/ICSI failed because of elevated SDF; and 3) testicular sperm will result in pregnancy or live birth when ejaculated sperm will not. It has been demonstrated that when comparing populations, SDF is greater in infertile than in fertile populations. In addition, SDF is negatively associated with pregnancy rates by IVF/ICSI with an odds ratio of 1.68 (1).
