Sperm DNA fragmentation: a key player in decision making

We read, with great interest, the commentary written by Wayland Hsaio on the “Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios” (1). The author acknowledges sperm DNA fragmentation as an important addition to conventional methods for assessment of sperm quality highlighting the need for practice guidelines to describe its utility in different clinical scenarios. The author has critically appraised the utility of SDF in varicocele, as a tool to indicate testicular sperm retrieval in patients with recurrent pregnancy loss after intracytoplasmic sperm injection (ICSI) and in patients with lifestyle risk factors. His comments which are probably echoed by many, are indeed legitimate warranting a response aimed to further clarify the appropriate application of SDF for male fertility evaluation.