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Testicular sperm over ejaculated sperm (when both are available)
WHERE DO WE GO FROM HERE?
Need more Basic Research & Good Clinical Studies (RCT)
To Determine if Testi-ICSI is
1. A valid approach (superior to Ejac-ICSI)
2. A safe approach (late complications)
To Establish Clinical Indications
1. Sperm profile (eg. High SDF)
2. Clinical profile (e.g. prior ICSI failure, all ICSI candidates)
Esteves, 45
Conclusions (2)
Testi-ICSI should be reserved to men who meet the following conditions:
1. High SDF in neat ejaculate measured by a reliable assay with a validated threshold
2. High SDF despite treatment of underlying condition (if applicable)
Esteves, 46
Any clinical decision towards Testi-ICSI should make clear to the patient the limitations of SDF testing and the possible benefits and risks of Testi-ICSI
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