A guide to sperm DNA fragmentation testing

A conundrum exists in the field of male infertility as in many other areas of medical study. It is described by the adage that advises one to not order a test or exam if you don’t know what to do with the results. The urologists’ conundrum is: how to use the information we have learned about abnormalities in sperm chromatin, specifically DNA fragmentation, in our daily practice. How to measure it, what are the qualitative and quantitative norms, what are the effects (on fertilization and pregnancy both natural and assisted) of deviations from these norms, is it treatable or just manageable with some sort of work-around? These are some of the questions the urologist/male fertility specialist must consider when he or she is requested to consult on a man referred for “evaluation of an abnormal sperm DNA fragmentation test”. These tests are relatively easy to obtain and at least one has been standardized and commercially available for a number of years. The article on “Clinical utility of sperm DNA fragmentation testing” addresses these issues (1).