Sperm DNA Fragmentation Testing: The Missing Link in Male Infertility Diagnosis
In the previous article, we explained the importance of SDF (sperm DNA fragmentation) testing in cases of male infertility.
Recently, a global study was conducted to investigate procedures related to SDF testing, to compare professional society guidelines and recommend expert advice.
India was high on the list of countries which participated in this study. The conditions of the patients were taken into account when deciding whether or not SDF testing was required.
UMI – Unexplained male infertility
Many specialists (over 50%) order SDF testing in couples with UMI, while almost 25% order SDF testing in all cases. A small percentage felt that SDF testing would not help the treatment plan.
Recommendation: SDF testing should be done for all UMI males, especially after workup and exclusion of all known causes. The testing can be done at diagnosis or after ART failure.
IMI – Idiopathic male infertility (reduced semen quality)
About half the participants said they would investigate SDF in some cases. 25% said they would undertake SDF testing in all cases while a slightly less percentage would not do SDF testing for IMI patients. Many order SDF testing after failure of ART, while about ⅓ do the SDF testing routinely. A less percentage order SDF testing for IMI before trying ART.
Recommendation: After a detailed diagnostic workup and excluding all known causes, SDF testing should be requested for all men with IMI, preferably before initiating ART.
RPL – Recurrent pregnancy loss:
RPL is usually when, after natural conception, 2 or more miscarriages take place. Many specialists said they would do a routine SDF testing with the initial work-up. About ⅓ would order the test only if the initial work up did not show any results. About the same number would request SDF testing before ART while the others would ask for it after ART failure. A minimum would not order it at all.
Recommendation: In spite of standard semen parameters, SDF testing should be included in the workup of any RPL client.
Risk factors and exposures:
Most specialists include SDF testing for infertile men with risk factors relating to high SDF, such as those who smoke or who have a history of chemotherapy or chemical/radiation exposure. A minority do not undertake the test for these conditions.
Recommendation: Those men with risk factors such as the above, as well as aging, obesity, alcohol and infections should undertake SDF testing and be informed that those factors could result in higher SDF.
Men with varicocele:
Many specialists do SDF testing after either failure of varicocele repair or ART. Some before referring for ART. In nearly 20% of the cases, the testing was carried out in the initial workup, for all patients with clinical varicocele and abnormal semen parameters.
Recommendation: Those with clinical varicocele may take the SDF test initially, especially if ART is planned. This will also help in deciding on varicocele repair. Those who continue with infertility even after varicocele repair should undergo SDF testing. Subclinical varicocele need not have the testing done, except to look for an alternative cause for the infertility.
For those planning ART:
Most specialists order SDF testing for men (who as couples are undergoing ART) “for certain indications”. While about 15% always do the testing before ART, about 20% do not.
Recommendation: SDF testing would benefit ART planning especially if linked to risk factors. However, this should be discussed with the couple. SDF testing should be done after ART failure for men with UMI or IMI, men over 40 years and with risk factors, if the female’s workup is normal.
Sperm cryopreservation: (sperm freezing and storage for future use)
The majority do not order SDF testing prior to sperm cryopreservation. However, about 40% agreed that, if high SDF was detected prior to cryopreservation, it would be treated depending on the condition of the patient.
Recommendation: No universal recommendation was taken. The testing before cryopreservations should be considered on a case-by-case basis, particularly if there are risks for SDF. If there is elevated SDF, it should be lowered before cryopreservation. If there is no time, then the patients should be informed and advised of the condition of their samples.
Conclusion: The society guidelines differed on many aspects, depending on the location. Most of these references were from America and Europe. However, as can be seen by the above studies and recommendations, SDF testing should be one of the major action courses to diagnose infertility so that appropriate measures can be taken for treatment.
We, at Andrology Center, possess cutting-edge equipment and advanced technology to conduct comprehensive semen analysis and SDF tests, ensuring accurate and standardised reports. We take pride in being the sole authorised laboratory in India that performs the reliable SCSA (sperm chromatin structure assay) test, which ensures a precise outcome. Equipped with these detailed reports, fertility specialists can effectively evaluate the results and offer optimal treatment choices for the couple.
