Evidence-based application of sperm DNA fragmentation testing

Very few disciplines of medicine have undergone significant and radical advances as reproductive medicine. Male infertility evaluation and treatment, only three decades ago, was in its most primitive form. With the introduction of ICSI, the treatment of male infertility has been revolutionized. However, the understanding and in depth evaluation of this disease has lagged behind the technical advances. The research for understanding the scientific basis of sperm malfunction has gone in many directions. Sperm DNA fragmentation testing has been highly controversial. How can a clinician decide of sperm DNA fragmentation results in different clinical scenarios? Dr. Agarwal and his colleagues have delineated, elaborated and outlined every application, limitation and utilization of sperm DNA fragmentation. Based on their decade long research and clinical experience in sperm DNA fragmentation, they were able to put together the pros, cons and conclusions in every situation that we can meet in practice. Fifty-eight fertility experts from 6 continents and 22 nations contributed commentaries on every aspect of sperm DNA fragmentation. These commentaries contained an abundance of information and conflicting views about the clinical utility of SDF testing, which underline the complex nature of SDF. In light of various contradictory and perplexing information prevalent amongst the specialists, Dr. Agarwal’s team prepared careful responses to each commentary using an evidence based approach. Their editorial replies offer amazing clarity on the use of SDF in the management of patients with male infertility under different clinical scenarios. I want to congratulate Dr. Agarwal and his team on their outstanding scientific contribution to the field of reproductive medicine. Their far-sightedness in this field has been truly fascinating. In your hands, our readers, we put a valuable volume that I hope you would enjoy as I did.