
In OAT patients with high sperm DNA fragmentation (SDF) and prior ICSI failures using ejaculated sperm, nearly half showed normal spermatogenesis but had signs of partial epididymal obstruction. Testicular sperm improved clinical pregnancy (45.8%) and live birth rates (36.1%), regardless of histology. Findings suggest obstructive defects may impair sperm maturation and DNA integrity, supporting testicular sperm use in select ICSI candidates.
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