Some Options to Optimize Male Gametes for ICSI

Introduction: The aim of the study was to discuss the androlog-ic approach to azoospermia, cryptozoospermia and oligoasthe-noteratozoospermia (OAT) in the era of the assisted reproduc-tive technology (ART), and the importance of predictive tests, like the DNA fragmentation index (DFI), to decide the sperm source (from testis or from ejaculate) for ART in male factor in-fertility. Also we summarize the effect of freezing sperm on the DFI and the ICSI outcome according to the current Literature. Material and Methods: The English literature was searched on PUBMED by the terms of: azoospermia, cryptozoospermia, OAT, DFI, ejaculated vs testicular sperm for cryptozoospermic or OAT patients, and predictive tests for ICSI. The only publi-cations in the most recent years about this subjects were evalu-ated. We will make a comment about every topics in the light of the Literature and compare it with our daily practice in this area. Results: In NOA, Micro-TESE is the sperm retrieval procedure of choice and testicular histology influences the success, with better results in cases of hypospermatogenesis.Testicular sperm are more advantageous for ICSI patients with cryptoozoospermia for take-home baby rate.DFI rate is lower in testicular sperm than in ejaculated sperm in the severe OAT patients.Testicular sperm are superior to ejaculated sperm for ICSI to achieve pregnancy in infertile males with high DFI. Cryopreservation of the fresh ejaculated sperm from normozoo-spermic patients can increase DFI, and negatively affect sperm progressive motility, viability and normal morphology. However in NOA, it seems there is no statistically difference between fresh and frozen-thawed testicular sperm with regards to fertilization rate, but no reliable data were found about im-plantation, miscarriage and live birth rates.Conclusion: Using DFI test before programming ICSI can help to decide the better sperm source selection (ejaculate, testicle), especially in cryptozoospermic and severe OAT patients.