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Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
August 14, 2023
Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
World J Men’s Health World J Men’s Health (IF: 5.4; Q1). Apr 10, 2023.
Preamble:
Sperm DNA damage refers to the structural abnormalities or breaks within the genetic material of sperm cells. It arises from oxidative stress, environmental toxins, and lifestyle factors. Defective sperm maturation and impaired DNA repair mechanisms contribute to sperm DNA damage. The intriguing aspect of human sperm DNA damage lies in its potential to impact fertility, miscarriage rates, and offspring health, highlighting the importance of understanding and addressing this intricate biological phenomenon.
(Contributor: Agarwal, A)
Capsule:
Until recently, male fertility testing has been relatively unchanged since the mid-17th century when Anthony van Leeuwenhoek identified spermatozoa microscopically. It is well established that conventional semen parameters are the cornerstone of the male fertility evaluation, and they are, without question, of a great deal of importance. However, they are a crude assessment of a man’s fertility. A criticism is that they give no data on the functionality of the individual’s sperm. Functional testing of sperm as an adjunct to conventional semen analysis is crucial for higher levels of understanding of sperm function and its potential impacts on clinical outcomes. The sperm DNA fragmentation (SDF) assay is the only test of advanced semen analysis to have the level of data to support its use in clinical practice. Due to the large body of scientific evidence, this test has been included in professional society guideline statements. Although it is considered a useful adjunct, there is controversy about when it is indicated with the current viewpoint that it should not be tested on all infertile men.
The publication entitled “Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations” explores when it is appropriate to obtain SDF testing. This study includes data from a survey of 436 experts from 55 countries to gain a global understanding of the appropriate use of SDF testing and practice patterns. The survey revealed that common indications for SDF testing worldwide include unexplained or idiopathic infertility, couples with recurrent pregnancy loss, men who are smokers, to help guide the need for varicocele repair, and prior to assisted reproductive technology in certain situations. Professional society guideline recommendations are also reviewed, and the lack of standardization is evident at this point among societies. (Contributor: Birowo, P)
Postscript:
As interest in SDF testing increases, it is essential to identify specific clinical scenarios where assessing the male partner's SDF status would significantly impact infertility management. Defining proper indications maximizes benefits while minimizing unfocused and excessive SDF testing among all infertile males. (Contributor: Agarwal, A)
Acknowledgment:
Ponco Birowo, MD, Ph.D.
Professor of Urology, Faculty of Medicine Universitas Indonesia
Cipto Mangunkusumo Hospital
Jakarta, Indonesia
Dr. Ashok Agarwal
Director of Research, Global Andrology Forum American Center for Reproductive Medicine Professor, Case Western Reserve University Emeritus Staff, Cleveland Clinic Foundation Associate Member, European Section of Andrological Urology, EAU President, Global Andrology Solutions, LLC Moreland Hills, OH United States