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Journal Article Review Ppublish 186 citations

PubMed: 33108829 DOI: 10.1111/and.13874

Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations.

Andrologia 53(2):e13874

Authors: Sandro C Esteves, Armand Zini, Robert Matthew Coward, Donald P Evenson, Jaime Gosálvez, Sheena E M Lewis, Rakesh Sharma, Peter Humaidan

Affiliations

  • ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil.
  • Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil.
  • Faculty of Health, Aarhus University, Aarhus, Denmark.
  • Division of Urology, Department of Surgery, St. Mary's Hospital, McGill University, Montreal, Québec, Canada.
  • Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
  • UNC Fertility, Raleigh, NC, USA.
  • SCSA Diagnostics, Brookings, SD, USA.
  • Sanford Medical School, University of South Dakota, Sioux Falls, SD, USA.
  • Unit of Genetics, Department of Biology, Universidad Autónoma de Madrid, Madrid, Spain.
  • Queens University Belfast, Belfast, UK.
  • Examenlab Ltd. Belfast, UK.
  • American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
  • Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark.

Abstract

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.

MeSH

Research Design, Fertility, Infertility, Dna Fragmentation, Infertility, Male, Genitalia, Male, Spermatozoa, Dna, Semen Analysis

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