Use of sperm DNA fragmentation testing and testicular sperm for intracytoplasmic sperm injection

Dr. Ahmad, in his well-written commentary (1), shared his viewpoints about the utility of sperm DNA fragmentation (SDF) testing on each clinical scenario proposed in the practice recommendations by Agarwal et al. (2). He highlighted the pitfalls of relying on quantitative semen parameters in current practice and the need for a more reliable diagnostic marker. The author agreed on the value of the practice recommendations in providing well-organized and diverse information for infertility practitioners, while he cautioned against the use of SDF testing as the first choice in routine infertility screening. We wish to expand on this point as well further discuss—the issue on the use of testicular sperm for intracytoplasmic sperm injection (ICSI) in the management of high SDF as raised by Dr. Ahmad.