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Transl Androl Urol. 2016 Dec;5(6):935-950. doi: 10.21037/tau.2016.10.03.

Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios.

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American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
Department of Urology, Glickman Urological and kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil.
Department of Urology, Loma Linda University, Loma Linda, California, USA.
Department of Urology, University of Miami, Miami, Florida, USA.
Department of Urology, McGill University, Montreal, Canada.


Sperm DNA fragmentation (SDF) has been generally acknowledged as a valuable tool for male fertility evaluation. While its detrimental implications on sperm function were extensively investigated, little is known about the actual indications for performing SDF analysis. This review delivers practice based recommendations on commonly encountered scenarios in the clinic. An illustrative description of the different SDF measurement techniques is presented. SDF testing is recommended in patients with clinical varicocele and borderline to normal semen parameters as it can better select varicocelectomy candidates. High SDF is also linked with recurrent spontaneous abortion (RSA) and can influence outcomes of different assisted reproductive techniques. Several studies have shown some benefit in using testicular sperm rather than ejaculated sperm in men with high SDF, oligozoospermia or recurrent in vitro fertilization (IVF) failure. Infertile men with evidence of exposure to pollutants can benefit from sperm DNA testing as it can help reinforce the importance of lifestyle modification (e.g., cessation of cigarette smoking, antioxidant therapy), predict fertility and monitor the patient's response to intervention.


Sperm DNA fragmentation (SDF); assisted reproductive technology (ART); male infertility; unexplained infertility; varicocele

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