An evidence-based perspective on the role of sperm chromatin integrity and sperm DNA fragmentation testing in male infertility

tau.amegroups.com © Translational Andrology and Urology. All rights reserved. We read with interest the commentary by Dr. Pandiyan and colleagues (1) about the merit of our recently published clinical practice guidelines for sperm DNA fragmentation (SDF) testing based on clinical scenarios (2). We noted that these authors were quite skeptic about the integration of SDF testing into the clinical workup of male infertility and management algorithms for couples embarking on assisted reproductive technology (ART). Their opinion is mainly based on the argument that most (or all) sperm function tests introduced in the last decades failed to provide useful information for clinical management of patients facing infertility. The authors argued that the role of molecular biology testing in infertility remains elusive, as does the association between SDF and infertility. In addition, the authors present their views about the futility of treating infertile men with varicocele. They go further by questioning varicocele as causative of male subfertility and argue that reactive oxygen species (ROS), which have been implicated in varicocele pathophysiology, bring more good than harm. Lastly, Dr. Pandiyan and colleagues advise against the use of sperm function tests, including SDF, given the effectiveness of ART. And they conclude with a quote from Edward Wallach—a Professor Emeritus of Gynecology at Johns Hopkins School of Medicine—that says “It is easy to fall prey to accepting an unproven therapy as dogma, while overlooking the basic principles responsible for infertility, especially when the overall climate encourages aggressiveness in the use of high-tech measures”. In our reply to the authors, we address their remarks and discuss the principles of why SDF is associated with infertility. While being respectful to their viewpoints and opinions, we provide readers with overwhelming proof embedded in science and medicine to scrutinize the commentary by Dr. Pandiyan and colleagues’ with a grain of salt.