Infertility has become a global issue affecting approximately 180 million people in today's world. Male factor infertility is present in about 10% of couples, and nearly half of infertility cases are attributed to male factors.
The integrity of sperm DNA, which carries the genetic material, is essential for the continuity of the species. An increase in sperm DNA fragmentation reduces the sperm's ability to fertilize an egg. Oxidative stress (the negative impact of free oxygen radicals on our cells) impairs sperm functions such as motility, sperm-zona pellucida interaction, acrosomal exocytosis, and sperm-egg fusion.
In fact, the effects of sperm DNA fragmentation on reproductive success are also dependent on the egg's DNA repair capacity. Sperm DNA damage can affect embryonic development and the health of the baby even after the egg's repair mechanisms have acted. Embryonic development can be disrupted due to sperm DNA damage, leading to failed implantation in the uterine wall or even miscarriage.
Various factors, such as varicocele, chronic diseases, infections in accessory glands, aging, lifestyle, obesity, occupational and environmental factors, medication use, ionizing or non-ionizing radiation, and heat exposure, are associated with sperm DNA fragmentation. These conditions generally increase sperm DNA fragmentation by contributing to defective spermatogenesis, cell death, or the formation of reactive oxygen species, which can lead to miscarriages.
The American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) do not recommend routine sperm DNA fragmentation testing among standard infertility tests. However, current ASRM guidelines suggest that varicocele repair and the use of antioxidants may reduce sperm DNA fragmentation.
In cases of unexplained infertility, recurrent pregnancy losses, low living standards, or a history of exposure to toxic substances, sperm DNA fragmentation testing may be considered if there are repeated failures in assisted reproductive technologies like IUI (intrauterine insemination), IVF (in vitro fertilization), or ICSI (intracytoplasmic sperm injection).
To improve pregnancy rates, varicocele repair and lifestyle modifications (quitting smoking and alcohol, addressing obesity, adopting a healthy diet, and engaging in regular exercise) are often sufficient.
