Routine assessment of sperm DNA fragmentation in clinical practice: commentary and perspective

A recent review proposed a guideline on the clinical utility of sperm DNA fragmentation (SDF) testing presented by four clinical scenarios in an evidence-based approach (1). This comprehensive review addressed commonly encountered clinical scenarios and provided practice based recommendations. Furthermore, it tried to explain the current indications of SDF testing as well as the management of increased SDF. Certainly, using clinical scenarios will be a useful reference for assisting practicing physicians in identifying the circumstances in which SDF testing is of greatest clinical value. It is well accepted that the diagnostic potential of conventional semen analysis is limited. However, semen analysis remains the first step and the cornerstone for evaluation of male fertility. The American Urological Associat ion (AUA) and the American Society for Reproductive Medicine (ASRM) recommended a thorough primary assessment of the infertile man that should contain a detailed medical and reproductive history, a physical examination and no less than two semen analyses (2,3). A real concern is that around 15% of men with normal conventional semen analysis profiles still complain of infertility which might be related to increased SDF (4,5). Many recent studies tried to address this issue and investigated the possible correlation between SDF and conventional sperm parameters (4,5). Most of studies reported a reversed association between SDF rate and sperm quality (6). On the contrary, several other studies were unable to demonstrate a significant association between the conventional seminal variables, such as sperm concentration, motility, vitality, morphology and SDF indices (7). The inconsistency among studies regarding the correlations between conventional seminal variables and SDF indices might be caused by several issues: (I) differences in the used procedures for DNA integrity testing; (II) differences in the techniques and applied criteria for assessment of the analysis of conventional semen parameters; (III) quality control in semen parameters testing and (IV) the selection criteria of the studied populations are not usually standardized (8,9).