Elucidating the clinical indications of sperm DNA fragmentation in male infertility

The commentary written by Arafa and ElBardisi on the “Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios” by Agarwal et al. (1) is clearly a valid addition to the SDF debate. We agree with the authors that compelling evidence exists signifying the detrimental role of SDF on male fertility (1-3). Semen samples from infertile men tend to have significantly higher levels of SDF, which are associated with a higher likelihood of spontaneous pregnancy loss (4). Furthermore, higher SDF was found to impact success rates of assisted reproductive techniques (ART) through its effect on oocyte fertilization, embryo quality, clinical pregnancy and live birth rate (5,6).