RE:Human Sperm DNA Fragmentation Test

Androlog Mail

Re: DNA testing

Dr. Lamb has clearly and concisely added to our discussion of DNA
damage and male infertility, as well as applicable tests. The ASRM
Practice Guideline does not recommend routine testing of sperm DNA
integrity testing of all patients before IVF but the authors
(primarily, me) left open the possibility that certain subsets of
patients (e.g., couples with recurrent miscarriage, failed IVF) could
benefit from such DNA integrity testing. A more recent meta-analysis
(<http://www.ncbi.nlm.nih.gov/sites//pubmed/17644094?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>Collins
JA, Barnhart KT, Schlegel PN. Do sperm DNA integrity tests predict
pregnancy with in vitro fertilization? Fertil Steril. 2007 Epub Jul
17) documents that abnormal DNA integrity results DO affect the
result of IVF and ICSI, although the effect is modest and there is no
cut-point of abnormal DNA integrity that would preclude use of
patient's sperm for IVF or ICSI.

Of note is that sperm processing removes most of the sperm with
damaged DNA, but the effect of the original sample's abnormal DNA
integrity remains for IVF/ICSI outcome.
Furthermore, we do not have treatments with clear, clinically
important effects on sperm DNA integrity. The effect of varicocele
repair is statistically significant, but numerically very
limited. Published literature on the use of testicular sperm to
avoid ejaculated sperm DNA damage is extremely limited, and the
effect of anti-oxidants (suggested in one or two poorly-performed
studies) is far from convincing. So, even if abnormal sperm DNA
integrity is identified, it's not always clear what you should do with it!

Clearly, this remains an evolving area where, as Dr. Lamb indicates,
more robust data are needed.

Peter N Schlegel, M.D.
pnschleg@med.cornell.edu
Received on Fri Jan 18 16:24:22 2008