Sperm DNA Fragmentation: A New Guideline for Clinicians
Agarwal Ashok, Majzoub Ahmad, Baskaran Saradha, Selvam Manesh Kumar Panner, Cho Chak Lam, Henkel Ralf, Finelli Renata, Leisegang Kristian, Sengupta Pallav, Barbarosie Catalina,
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( Agarwal Ashok )
Cleveland Clinic American Center for Reproductive Medicine
( Majzoub Ahmad )
Hamad Medical Corporation Department of Urology
( Baskaran Saradha )
Cleveland Clinic American Center for Reproductive Medicine
( Selvam Manesh Kumar Panner )
Cleveland Clinic American Center for Reproductive Medicine
( Cho Chak Lam )
Union Hospital Department of Surgery
( Henkel Ralf )
Imperial College London Department of Metabolism, Digestion and Reproduction
( Finelli Renata )
Cleveland Clinic American Center for Reproductive Medicine
( Leisegang Kristian )
University of Western Cape Faculty of Community and Health Sciences School of Natural Medicine
( Sengupta Pallav )
MAHSA University Faculty of Medicine, Bioscience and Nursing Department of Physiology
( Barbarosie Catalina )
University of Bucharest Faculty of Biology Department of Genetics
Abstract
Sperm DNA integrity is crucial for fertilization and development of healthy offspring. The spermatozoon undergoes extensive molecular remodeling of its nucleus during later phases of spermatogenesis, which imparts compaction and protects the genetic content. Testicular (defective maturation and abortive apoptosis) and post-testicular (oxidative stress) mechanisms are implicated in the etiology of sperm DNA fragmentation (SDF), which affects both natural and assisted reproduction. Several clinical and environmental factors are known to negatively impact sperm DNA integrity. An increasing number of reports emphasizes the direct relationship between sperm DNA damage and male infertility. Currently, several assays are available to assess sperm DNA damage, however, routine assessment of SDF in clinical practice is not recommended by professional organizations. This article provides an overview of SDF types, origin and comparative analysis of various SDF assays while primarily focusing on the clinical indications of SDF testing. Importantly, we report four clinical cases where SDF testing had played a significant role in improving fertility outcome. In light of these clinical case reports and recent scientific evidence, this review provides expert recommendations on SDF testing and examines the advantages and drawbacks of the clinical utility of SDF testing using Strength-Weaknesses-Opportunities-Threats (SWOT) analysis.
키워드
Assisted reproductive techniques outcome; Clinical guidelines; Infertility, male; Oxidative stress; Sperm DNA fragmentation
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