Sperm DNA fragmentation: A new guideline for clinicians

Ashok Agarwal, Ahmad Majzoub, Saradha Baskaran, Manesh Kumar Panner Selvam, Chak Lam Cho, Ralf Henkel, Renata Finelli, Kristian Leisegang, Pallav Sengupta, Catalina Barbarosie, Neel Parekh, Marco G. Alves, Edmund Ko, Mohamed Arafa, Nicholas Tadros, Ranjith Ramasamy, Parviz Kavoussi, Rafael Ambar, Manish Kuchakulla, Kathy Amy RobertConcetta Iovine, Damayanthi Durairajanayagam, Sunil Jindal, Rupin Shah

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


Sperm DNA integrity is crucial for fertilization and development of healthy offspring. The spermatozoon undergoes extensive molecular remodeling of its nucleus during later phases of spermatogenesis, which imparts compaction and protects the genetic content. Testicular (defective maturation and abortive apoptosis) and post-testicular (oxidative stress) mechanisms are implicated in the etiology of sperm DNA fragmentation (SDF), which affects both natural and assisted reproduction. Several clinical and environmental factors are known to negatively impact sperm DNA integrity. An increasing number of reports emphasizes the direct relationship between sperm DNA damage and male infertility. Currently, several assays are available to assess sperm DNA damage, however, routine assessment of SDF in clinical practice is not recommended by professional organizations. This article provides an overview of SDF types, origin and comparative analysis of various SDF assays while primarily focusing on the clinical indications of SDF testing. Importantly, we report four clinical cases where SDF testing had played a significant role in improving fertility outcome. In light of these clinical case reports and recent scientific evidence, this review provides expert recommendations on SDF testing and examines the advantages and drawbacks of the clinical utility of SDF testing using Strength-Weaknesses-Opportunities-Threats (SWOT) analysis.

Original languageEnglish (US)
JournalWorld Journal of Men?s Health
StatePublished - Jul 2020


  • Assisted reproductive techniques outcome
  • Clinical guidelines
  • Infertility
  • Male
  • Oxidative stress
  • Sperm DNA fragmentation

ASJC Scopus subject areas

  • Aging
  • Reproductive Medicine
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health
  • Urology
  • Pharmacology (medical)


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