Sperm DNA fragmentation testing as a diagnostic and prognostic parameter of couple infertility

In Western countries, approximately 15% of couples are infertile as defined by inability to conceive after one year of unprotected intercourse. Male factors are present in about half of infertile couples, either alone or in combination with female causes. Although many progresses have been made in last years in the field of human reproduction, male fertility and assisted reproduction techniques, both in basic research and diagnostic tools, standard semen analysis remains the mainstream for further decision-making investigations in infertile males. Indeed, semen analysis, when correctly executed following World Health Organization (WHO) guidelines (1), gives clinically important information not only on the fertility potential of a man but also on the general health status of the male reproductive tract. What it is erroneously thought is that diagnosis of male (in) fertility is completed after just semen analysis. Technology and assisted reproduction erroneously prompted the concept that full medical investigation for infertile men is not necessary and male infertility is often defined only based on semen analysis. Indeed, male infertility can be caused by a variety of aetiologies, and semen parameters merely represent the end point of different pathophysiologic mechanisms (2,3).