We herein summarise the evidence concerning the impact of sperm DNA fragmentation in various clinical infertility scenarios and the advances on sperm DNA fragmentation tests. The collected evidence was used to formulate 41 recommendations. Of these, 13 recommendations concern technical aspects of sperm DNA fragmentation testing, including pre-analytical information, clinical thresholds and interpretation of results. The remaining 28 recommendations relate to indications for sperm DNA fragmentation testing and clinical management. Clinical scenarios like varicocele, unexplained infertility, idiopathic infertility, recurrent pregnancy loss, intrauterine insemination, in vitro fertilisation/intracytoplasmic sperm injection, fertility counselling for men with infertility risk factors and sperm cryopreservation have been contemplated. The bulk evidence supporting the recommendations has increased in recent years, but it is still of moderate to low quality. This guideline provides clinicians with advice on best practices in sperm DNA fragmentation testing. Also, recommendations are provided on possible management strategies to overcome infertility related to sperm DNA fragmentation, based on the best available evidence. Lastly, we identified gaps in knowledge and opportunities for research and elaborated a list of recommendations to stimulate further investigation.
sperm DNA fragmentation testing, SDF clinical practice recommendations, sperm DNA integrity assessment, DNA damage male infertility, sperm chromatin structure assay, TUNEL test sperm quality, comet assay sperm DNA, SDF IVF ICSI outcomes, sperm DNA fragmentation miscarriage, male factor DNA damage diagnosis
PMID 33108829 33108829 DOI 10.1111/and.13874 10.1111/and.13874 Esteves et al. 2020, Esteves 2020
Cite this article
Esteves, S. C., Zini, A., Coward, R. M., Evenson, D. P., Gosálvez, J., Lewis, S. E. M., Sharma, R., & Humaidan, P. (2021). Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations. Andrologia, 53(2), e13874. https://doi.org/10.1111/and.13874
Esteves SC, Zini A, Coward RM, Evenson DP, Gosálvez J, Lewis SEM, et al. Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations. Andrologia. 2021;53(2):e13874. doi:10.1111/and.13874
Esteves, S. C., et al. "Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations." Andrologia, vol. 53, no. 2, 2021, pp. e13874.
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