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Sperm DNA Fragmentation: A New Guideline for Clinicians

Agarwal A 1 , Majzoub A 2 , Baskaran S 3 , Panner Selvam MK 3 , Cho CL 4 , Henkel R 5 Show all authors , Finelli R 3 , Leisegang K 6 , Sengupta P 7 , Barbarosie C 8 , Parekh N 9 , Alves MG 10 , Ko E 11 , Arafa M 2 , Tadros N 12 , Ramasamy R 13 , Kavoussi P 14 , Ambar R 15 , Kuchakulla M 13 , Robert KA 3 , Iovine C 16 , Durairajanayagam D 17 , Jindal S 18 , Shah R 19

Affiliations 

  • 1 American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA. agarwaa@ccf.org
  • 2 Department of Urology, Hamad Medical Corporation, Doha, Qatar
  • 3 American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
  • 4 Department of Surgery, Union Hospital, Hong Kong
  • 5 Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
  • 6 School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
  • 7 Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Malaysia
  • 8 Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
  • 9 Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
  • 10 Department 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
  • 11 Department of Urology, Loma Linda University, Loma Linda, CA, USA
  • 12 Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
  • 13 Department of Urology, University of Miami, Miami, FL, USA
  • 14 Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
  • 15 Urology Department of Centro Universitario em Saude do ABC, Santo André, Brazil
  • 16 Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
  • 17 Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
  • 18 Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
  • 19 Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
World J Mens Health, 2020 Oct;38(4):412-471.
PMID: 32777871 DOI: 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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