title: Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios.
abstract: Sperm DNA fragmentation (SDF) has been generally acknowledged as a valuable tool for male fertility evaluation. While its detrimental implications on sperm function were extensively investigated, little is known about the actual indications for performing SDF analysis. This review delivers practice based recommendations on commonly encountered scenarios in the clinic. An illustrative description of the different SDF measurement techniques is presented. SDF testing is recommended in patients with clinical varicocele and borderline to normal semen parameters as it can better select varicocelectomy candidates. High SDF is also linked with recurrent spontaneous abortion (RSA) and can influence outcomes of different assisted reproductive techniques. Several studies have shown some benefit in using testicular sperm rather than ejaculated sperm in men with high SDF, oligozoospermia or recurrent in vitro fertilization (IVF) failure. Infertile men with evidence of exposure to pollutants can benefit from sperm DNA testing as it can help reinforce the importance of lifestyle modification (e.g., cessation of cigarette smoking, antioxidant therapy), predict fertility and monitor the patient's response to intervention.
authors.affiliation: American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Urology, Glickman Urological and kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Majzoub
authors.affiliation: ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil.
authors.forename: Sandro C
authors.initials: SC
authors.lastname: Esteves
authors.affiliation: Department of Urology, Loma Linda University, Loma Linda, California, USA.
authors.forename: Edmund
authors.initials: E
authors.lastname: Ko
authors.affiliation: Department of Urology, University of Miami, Miami, Florida, USA.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Ramasamy
authors.affiliation: Department of Urology, McGill University, Montreal, Canada.
authors.forename: Armand
authors.initials: A
authors.lastname: Zini
keywords: Sperm DNA fragmentation (SDF); assisted reproductive technology (ART); male infertility; unexplained infertility; varicocele