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

Ashok Agarwal, Ahmad Majzoub, Sandro C. Esteves, Edmund Ko, Ranjith Ramasamy, Armand Zini

Research output: Contribution to journalArticlepeer-review

240 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)935-950
Number of pages16
JournalTranslational Andrology and Urology
Issue number6
StatePublished - 2016


  • Assisted reproductive technology (ART)
  • Male infertility
  • Sperm DNA fragmentation (SDF)
  • Unexplained infertility
  • Varicocele

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology


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