Either testicular sperm aspiration or microsurgical testicular dissection, followed by IVF/ICSI. Studies have shown using testicular sperm carries less DNA fragmentation compared to ejaculated sperm and improves fertilization and pregnancy rates.

Thanks Nishant.

Nice suggestion

I`m going to present to my human reproduction group.

I`ll let you know about our observations

Teloken

I agree with Nishant.

Samples with more than 50% damage will not do well with IVF. They may do better with ICSI although we know that IVF and ICSI have higher rates of miscarriage with DNA damaged sperm. I don't agree that DNA damage is apoptotic. We have shown no relationships between damage and apoptotic markers. it is more likely to be oxidative damage. Best Sheena Lewis

Here are some things to do before thinking of testicular sperm!

Adjust lifestyle factors known to cause DNA damage (e.g. smoking "in both partners").

Encourage the patient to eat food rich in antioxidants (fruit, veg, dried tomatoes etc)

Prescribe antioxidants for 3 to 6 months. We have good experience with astaxanthin either alone or combined with other antioxidants in reducing DNA damage (link below)

Exclude antisperm antibodies as a cause. If the test can not be performed on sperm due to low motility, test serum using the indirect MAR test (IgG). If positive, make the patient ejaculate directly into medium with additional 3% human serum albumin added to medium. Use a density gradient.

In any case, use a density gradient to recover sperm with a better DNA.

Perform ICSI and blastocyst transfer (Simon et al Hum. Reprod. 2014; 29 (11): 2402-2412)

Combined conventional/antioxidant "Astaxanthin" treatment for male infertility: a double blind, randomized trial. F H Comhaire, Y El Garem, A Mahmoud, F Eertmans, F Schoonjans Asian Journal of Andrology 2005; 7 (3): 257–262 .257

https://www.researchgate.net/profile/Ahmed_Mahmoud29/contributions?ev=prf_act

There are various causes of sperm DNA damage with reactive oxygen species ROS one. The damage from ROS occurs in the epididymis. Reducing ROS exposure time by reduced epididymis transit time is one simple treatment. This is achieved by frequent ejaculation. At ESHRE 2009 we presented our study of 118 men who ejaculated daily for 7 days. 82% showed a DFI reduction , mean 12 %. Sperm count reduced, motility increased, morphology remained the same.

A simple treatment with a larger randomized study to come.

Hi David,

Delighted to hear that. I chased your abstract to see if it was published anywhere so I could cite it. Any interest in trying the Comet test. It gives so much more information than any other test.

Send me your email and I will forward you our data,

Best wishes,

Sheena Lewis