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What can be done?
1. Sourceofsperm
– ejaculated vs testicular sperm
2. Durationofabstinence
3. Spermpreparationmethods 4. Useofanti‐oxidants
Men with high SDF may benefit from Testi‐ ICSI: Systematic review and meta‐analysis
• Normo‐ and oligozoospermic men with high SDF for ICSI with testicular (Testi‐ICSI) or ejaculated spermatozoa (Ejac‐ICSI).
• 5 studies (143 patients): SDF for testi‐ (8.95.1%) < ejacu‐ (33.412.8%) spermatozoa (95% CI ‐32.53 to ‐16.64; P<0.001).
• 4 studies (507 cycles): no difference in fertilization, lower trend with Testi‐ICSI. Test‐ICSI had
• Higher CPRs (50.0% vs 29.4%; 95% CI 1.57–3.73; P<.001)
• Higher LBRs (46.9% vs 25.6%; 95% CI 1.54–4.35, P<.001)
• Lower miscarriage rates (9.4% vs 29.1%; 95% CI 0.11–0.68; P<.005).
Esteves et al. (2017) Fertil Steril. 108:456‐467
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