Following the first successful birth in 1978 using assisted reproductive technology (ART) including in vitro fertilization, the use of ART has steadily increased. It became clear that as many as 40% of the inseminated in vitro cycles were affected by fertilization failure or extremely low fertilization.  

This was particularly noticeable in patients with decreased seminal parameters and poor sperm quality. The packaging of DNA in sperm and its integrity has important fertility related implications. Higher quality sperm DNA is theorized to be associated with higher pregnancy rates.

Three general sources of sperm are available for ART; ejaculated sperm, sperm retrieved from the epididymis (testes drainage tubes), the process is also known as MESA, and sperm retrieved from inside the testicles, the process is known as TESE.  

Some men have very low concentrations of ejaculated sperm, defined as less than 1×10^6/ml.  These men were noted to have decreased ART success rates compared to men with higher sperm counts.

Reproductive specialists at Cornell reported (in Stahl JP Methods of Mol Biol 2014) their observations of ART success from men with very low sperm counts. The highest egg fertilization rate occurred in ejaculated sperm but the highest clinical pregnancy rate (sign of a viable fetus) was seen in retrieved epididymis sperm. It was observed that cycles using testicular sperm had the lowest fertilization rates. Ejaculated low concentration sperm often has decreased sperm DNA quality.

Men with very low concentration and poor quality ejaculated sperm should discuss which sperm should be used for ART. The assisting reproductive urologist should counsel them on the pros and cons of using ejaculated sperm versus MESA versus TESE sperm sources, depending on the patient’s clinical presentation. Are you interested in learning about your Sperm DNA? We offer testing at The Y Factor and can assist in deciding the quality of sperm.

Some men, with the help of fertility treatment, can increase the concentration and quality of ejaculated sperm, avoiding a sperm retrieval (MESA/TESE) surgery.

In summary, what is the best sperm to use for ART? The best sperm is the highest quality sperm with the best DNA. This can be ejaculated sperm in men with high sperm counts or freshly retrieved sperm from the epididymis (MESA) or the testes (TESE).  The most important take home message is the reproductive urologist is the best advocate for men with fertility problems. If you have questions, please book an appointment today at one of our six locations so we can help you decide the best way forward. 

Russel H. Williams, MD

Dr. Russel H. Williams is the founder, CEO and CMO of The Y Factor and brings more than 20 years of experience. Dr. Williams earned his Medical Degree at the University of Texas at Dallas Southwestern Medical Center, where he graduated at the top of his class. He completed his urology residency at Baylor College of Medicine in Houston, then completed a male reproductive medicine and microsurgery visiting fellowship at the New York-Presbyterian/Weill Cornell Medical Center in Manhattan, New York. Dr. Williams is an active member of the American Urological Association, American Society for Reproductive Medicine, and peers recognize him as one of only a handful of Reproductive Urologists focusing on men’s urological wellness & fertility.