Understanding sperm DNA fragmentation

We greatly value the commentary by Dr. Gosalvez on the “Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios” by Agarwal et al. (1). The author initiated his well-written note with an overview of the structural and physiologic significance of sperm DNA on male reproduction addressing its association with varicocele, recurrent spontaneous abortion and unexplained infertility, and its implications on embryonic development and fecundity both naturally and after assisted reproductive techniques (ART). Throughout his discussion, Dr. Gosalvez rightly highlighted the importance of understanding the etiology, root causes and types of sperm DNA fragmentation (SDF) as this would ultimately influence interpretation of SDF test result and our understanding of the novel treatment methods utilized in such circumstances. We want to seize this opportunity to elaborate on this particular issue.