Beyond the Ejaculate: Unlocking Fertility Potential in Patients with High-Sperm DNA Fragmentation

Hashem, Esraa Mahmoud; Elshamy, M M; Abou-El-Naga, Amoura M

doi:10.21608/ejhm.2025.427528.1849

Beyond the Ejaculate: Unlocking Fertility Potential in Patients with High-Sperm DNA Fragmentation

Document Type : Original Article

Authors

¹ Zoology department , faculty of science , mansoura university

² Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University,egypt

³ Zoology Department, Faculty of Science, Mansoura University,egypt

10.21608/ejhm.2025.427528.1849

Abstract

Background: High sperm DNA fragmentation (SDF) significantly impairs reproductive outcomes in assisted reproductive technologies (ART), contributing to male factor infertility that affects 15% of couples globally.
Aim: This study investigated how sperm origin (testicular vs. ejaculated) and sperm selection methods (polyvinylpyrrolidone “PVP” vs. Sperm Slow) influence intracytoplasmic sperm injection (ICSI) outcomes in couples experiencing recurrent ART failures due to high SDF.
Methods: This randomized, single-blind clinical trial involved 200 couples with high SDF and prior ICSI failures. Participants were divided into two main groups for sibling oocyte injection: (1) ejaculated versus testicular aspirated sperm and (2) ejaculated sperm (prepared by density gradient) further selected using either PVP or Sperm Slow. We assessed fertilization, cleavage, blastocyst formation, and pregnancy rates.
Results: Testicular aspirated sperm yielded significantly superior outcomes compared to ejaculated sperm, showing higher fertilization rates and significantly improved pregnancy rates. Among selection methods, Sperm Slow outperformed PVP, resulting in better fertilization and pregnancy rates. Notably, aspirated sperm demonstrated higher fertilization and pregnancy rates even when compared directly to ejaculated sperm prepared with Sperm Slow.
Conclusion: Utilizing testicular sperm significantly improves ICSI outcomes for couples with high SDF and previous ART failures. When testicular sperm retrieval isn't an option, Sperm Slow appears to be a more effective sperm selection method than PVP for ejaculated sperm in this challenging patient population.

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