Ferlin, A. (2017). Sperm DNA fragmentation testing as a diagnostic and prognostic parameter of couple infertility. Translational andrology and urology. https://doi.org/10.21037/tau.2017.06.10
Ferlin A. Sperm DNA fragmentation testing as a diagnostic and prognostic parameter of couple infertility. Translational andrology and urology. 2017. doi:10.21037/tau.2017.06.10
Ferlin, Alberto. "Sperm DNA fragmentation testing as a diagnostic and prognostic parameter of couple infertility." Translational andrology and urology, 2017.
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RRM Academy Synopsis
Sperm DNA fragmentation tests lack evidence for routine use
A 2017 editorial says the value of sperm DNA damage tests is still debatable and lacks clinical evidence. Leading medical groups do not recommend them for infertile men. A semen test alone cannot finish the diagnosis.
Key Findings
About 15% of couples in Western countries are infertile, meaning no pregnancy after a year without contraception. Male factors are involved in about half of these couples, alone or alongside female causes.
Semen analysis reports fertility potential and the health of the testes and seminal tract. The author says it gives no diagnosis of cause, so no therapy should start from it alone.
AUA, EAU, NICE and ASRM do not recommend sperm DNA fragmentation testing in the evaluation of the infertile male. Randomized, controlled, prospective clinical trials on the topic are lacking.
Agarwal and colleagues suggest testing for varicocele, unexplained infertility, recurrent pregnancy loss, recurrent ART failure and lifestyle risks. Their evidence grade is very low, mostly grade C, from weak study designs.
Interpretation
The paper is a single-author commentary. It reports no new patient data and rests on the author's reading of the literature and a companion article by Agarwal and colleagues. The author states that the different tests assess different kinds of DNA damage, that standardization has not been reached for some of them, and that little is known about how much damage an egg can repair. The author's own view is that testing could add information, especially in men with normal semen parameters, after a careful diagnostic approach.
RRM Context
The author describes male infertility as having many causes. Semen results are the end point of different mechanisms. Restorative reproductive medicine looks at both partners to find causes before treatment starts. A semen test is one input.
Our editorial summary of this paper, not the article's abstract.
Abstract
In Western countries, approximately 15% of couples are infertile as defined by inability to conceive after one year of unprotected intercourse. Male factors are present in about half of infertile couples, either alone or in combination with female causes. Although many progresses have been made in last years in the field of human reproduction, male fertility and assisted reproduction techniques, both in basic research and diagnostic tools, standard semen analysis remains the mainstream for further decision-making investigations in infertile males. Indeed, semen analysis, when correctly executed following World Health Organization (WHO) guidelines (1), gives clinically important information not only on the fertility potential of a man but also on the general health status of the male reproductive tract. What it is erroneously thought is that diagnosis of male (in) fertility is completed after just semen analysis. Technology and assisted reproduction erroneously prompted the concept that full medical investigation for infertile men is not necessary and male infertility is often defined only based on semen analysis. Indeed, male infertility can be caused by a variety of aetiologies, and semen parameters merely represent the end point of different pathophysiologic mechanisms (2,3).