GLOBAL ANDROLOGY FORUM
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Sperm DNA Fragmentation: A New Guideline for Clinicians
Jun 11, 2023
Sperm DNA Fragmentation: A New Guideline for Clinicians.,
Agarwal A, Majzoub A, Baskaran S, Panner Selvam MK, Cho CL, Henkel R, Finelli R, Leisegang K, Sengupta P, Barbarosie C, Parekh N, Alves MG, Ko E, Arafa M, Tadros N, Ramasamy R, Kavoussi P, Ambar R, Kuchakulla M, Robert KA, Iovine C, Durairajanayagam D, Jindal S, Shah R. World J Mens Health. 2020 Oct;38(4):412-471.
https://doi.org/10.5534/wjmh.200128
CAPSULE:
This article focuses on the clinical significance of Sperm DNA Fragmentation (SDF) testing in the management of male infertility. It provides an overview of the underlying mechanisms and risk factors of SDF, as well as the different clinical tests associated with DNA fragmentation. The article also discusses the indications for SDF testing and presents case scenarios of male infertility with high SDF. SDF is known to negatively impact fertilization, embryo development, and the success of assisted
reproductive technologies (ART). Consequently, SDF testing is increasingly being used in the evaluation of male infertility. The causes of SDF can be endogenous, resulting from defective maturation and abortive apoptosis in the testes, or exogenous, stemming from clinical diseases, lifestyle factors, and environmental exposures. Although a universally agreed-upon cut-off value has not been established, a threshold of 20% is commonly considered to have good discriminative accuracy between fertile and infertile men.
The article identifies specific clinical scenarios where SDF testing is most beneficial, such as unexplained infertility, recurrent pregnancy loss (RPL), varicocele, patients opting for ART, and those with lifestyle or environmental risk factors. For patients with high SDF results, several therapeutic interventions can be implemented to improve their chances of conception. These include recurrent ejaculation, antioxidant therapy, lifestyle modifications, varicocelectomy (surgical treatment for varicocele), and advanced sperm selection techniques or testicular sperm for intracytoplasmic sperm injection (ICSI).
Overall, SDF testing plays a crucial role in assessing male infertility and can guide appropriate management strategies to enhance fertility outcomes in affected individuals.