The aim of this study is to investigate the results of intracytoplasmic sperm injection (ICSI) in patients with previous failure and suffering from high sperm DNA fragmentation index (SDF) when using testicular spermatozoa instead of ejaculate spermatozoa. This study involved 107 patients, all of them were with SDF >22% and previous ejaculate ICSI failure. This study examines the embryonic factors (fertilization, cleavage, and blastocyst formation) that resulted from ICSI using testicular and ejaculate sperms. In cases with high SDF that were detected using sperm chromatin dispersion assay (SCD assay) in ICSI program, testicular sperms extraction fine needle aspiration technique (FNA group) was used instead of ejaculate sperms (ejaculate group). There was no significance difference between FNA and ejaculate groups in oocyte fertilization rate and embryo cleavage rate (P < 0.005) while blastocysts formation rate was higher significance in FNA group than ejaculate group (P > 0.001), while pregnancy rate was 69.16 % positive, and 30.84 % negative, and implantation rate was 30%. Average of embryo transferred by cycle 2±1 /cycle and resulted in 91 live birth in healthy twins or singlet babies, abortion rate was 10%. In conclusion, this study suggested that improved ICSI outcomes for men with increased SDF were associated with the utilization of a testicular sperm obtained by FNA method.