Should a Couple with Failed In Vitro Fertilization or Intracytoplasmic Sperm Injection and Elevated Sperm DNA Fragmentation Use Testicular Sperm for the Next Cycle?

There is growing evidence indicating that intracytoplasmic sperm injection with testicular sperm rather than ejaculated sperm might be advantageous in achieving pregnancy for couples in which the male has high levels of sperm DNA fragmentation (SDF). Meta-analysis has shown that SDF rates are markedly lower in testicular sperm than in ejaculated sperm, and the odds of achieving pregnancy and a live birth are significantly higher.