Clinical utility of sperm DNA fragmentation testing: a requisite to infertility practice

tau.amegroups.com © Translational Andrology and Urology. All rights reserved. Conventional semen analysis is the routine test performed during the evaluation of a couple’s fertility status. The test is cost-effective and easy to perform and at the same time provides essential information on quantitative semen parameters such as semen volume, sperm motility, concentration, viability and morphology. Most practitioners consider a male partner normal or abnormal merely looking at a semen report. Notwithstanding that a semen analysis can provide significant information on sperm fertility parameters as predictive for fertilization; it does not forecast sperm functional and qualitative defects such as sperm DNA integrity, oxidative stress and antisperm antibodies (1,2). It also makes decision making difficult for the providers in certain clinical situations because of it’s inherit variability (3). Further, the advent of assisted reproductive technology (ART) has revolutionized the infertility treatment by offering, classic In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) in patients with abnormal semen parameters (4). On the other hand failed Intra Uterine Insemination (IUI), IVF/ICSI cycles and pregnancy loss have been reported in cases where semen parameters were normal (4,5). Additionally, the limitations of conventional semen analysis are extended into unexplained infertility cases where men had normal sperm parameters (6,7). The above challenges in infertility treatment, over the past few decades, have led the scientists to dig deep into the male gamete in the urge to improve the diagnosis of couple’s infertility by providing more effective and reliable diagnostic marker(s). One of such diagnostic markers is sperm DNA fragmentation (SDF). The utility and effeteness of SDF testing is comprehensively described in the paper “Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios” (4). This paper provides extensive literature based evidence, a coherent and rational guide on the utility of SDF testing in four different scenarios which every practitioner deals with during his/her practice. In relation to one case scenario, the authors have shown high pregnancy rates after surgical treatment of varicoceles in patients who had high SDF (8,9). Though it warrants further studies, in infertile varicocele patients with borderline to normal quantitative sperm parameters, SDF testing can be helpful in identification of the patients requiring varicocele treatment. SDF testing may be recommended in grade 1 varicocele patients with borderline or abnormal sperm parameters and grade 2/3 with normal semen parameters with the supporting evidence that surgical treatment has significantly improved semen quality and spontaneous pregnancy rates (10). SDF can be used as an effective tool to identify patients with recurrent pregnancy loss and failed IUI cycles (11,12). This review discusses a scenario of unexplained infertility in a young couple with history of recurrent pregnancy loss. Although controversies exist, strong evidence suggests that unexplained infertility may be caused by high SDF. A significantly higher percentage of population (17.7%) with unexplained infertility has shown SDF index above 30% compared to fertile controls (10.5%) (13). Likewise, higher Commentary