Improving Embryo and Sperm Quality Before ICSI

Understanding Oxidative Stress and Fertility

Oxidative stress is a major factor in male infertility, affecting sperm quality and function, as well as sperm DNA integrity 1, 2
Oxidative stress can lead to sperm DNA damage, reduced DNA integrity, and is associated with poor fertilization, embryo development, miscarriage, and implantation failure 1, 2
Environmental exposures and poor lifestyle choices are significant contributors to oxidative stress 1

Smoking cessation is strongly recommended as non-smokers have higher chances of pregnancy (OR = 2.23) 3
Weight loss for obese patients and regular physical exercise can enhance sperm parameters 3
Spermatogenesis takes approximately 74 days (about 2.5 months), so interventions should be started at least this far in advance of ICSI 3

Genetic testing should be performed for men with severe oligozoospermia or non-obstructive azoospermia before any therapeutic procedure 4, 5
Testicular sperm extraction may be considered for men with high sperm DNA fragmentation levels, as testicular sperm has lower fragmentation levels than ejaculated sperm 1, 2
Avoid testosterone monotherapy as it can suppress sperm production 6, 7

Routine measurement of reactive oxygen species is not currently recommended due to lack of standardized testing methods 1, 2
The European Association of Urology does not recommend routine testing of reactive oxygen species 1
Medical treatments for idiopathic oligoasthenoteratozoospermia have limited efficacy and may delay more effective assisted reproductive technology options 3
Sperm cryopreservation should be considered before any treatments that might further impair fertility 3

Cryopreserved testicular sperm retain significantly lower DNA fragmentation compared with fresh ejaculated sperm, indicating that the freeze‑thaw process does not markedly increase DNA damage in testicular specimens 8

While cryopreservation does not substantially alter sperm DNA fragmentation, it leads to a pronounced reduction in progressive motility after thawing 8