World J Mens Health.
2020 Oct;38(4):412-471. 10.5534/wjmh.200128.
Sperm DNA Fragmentation: A New Guideline for Clinicians
- Agarwal A
1 - Majzoub A2,3
- Baskaran S1
- Panner Selvam MK1
- Cho CL4,5
- Henkel R6,7
- Finelli R1
- Leisegang K8
- Sengupta P9
- Barbarosie C10
- Parekh N11
- Alves MG12
- Ko E13
- Arafa M2,14
- Tadros N15
- Ramasamy R16
- Kavoussi P17
- Ambar R18
- Kuchakulla M16
- Robert KA1
- Iovine C19
- Durairajanayagam D20
- Jindal S21
- Shah R22
- Affiliations
-
- 1American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
- 2Department of Urology, Hamad Medical Corporation, Doha, Qatar.
- 3Department of Urology, Weill Cornell Medicine - Qatar, Doha, Qatar.
- 4Department of Surgery, Union Hospital, Hong Kong.
- 5S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong.
- 6Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
- 7Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.
- 8School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa.
- 9Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Malaysia.
- 10Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
- 11Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA.
- 12Department of Microscopy, Laboratory of Cell Biology & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
- 13Department of Urology, Loma Linda University, Loma Linda, CA, USA.
- 14Andrology Department, Cairo University, Giza, Egypt.
- 15Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
- 16Department of Urology, University of Miami, Miami, FL, USA.
- 17Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.
- 18Urology Department of Centro Universitario em Saude do ABC, Santo André, Brazil.
- 19Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, Caserta, Italy.
- 20Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
- 21Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India.
- 22Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
- KMID: 2506412
- DOI: http://doi.org/10.5534/wjmh.200128
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.
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