Sperm DNA fragmentation: association with infertility and methods of correction

Abstract

In 2021, the assessment of sperm DNA fragmentation level was included in the World Health Organization guidelines as a diagnostic method for male infertility. The inability to conceive naturally, abnormal embryo development, increased miscarriage rates, decreased live birth rates, and decreased effectiveness of in vitro fertilization, intracytoplasmic sperm injection, and intrauterine insemination are all associated with high levels of sperm DNA fragmentation. The major causes that compromise the integrity of the genetic material of gametes include errors in chromatin condensation, incomplete apoptosis, and oxidative stress. Among the methods to overcome infertility associated with high levels of DNA fragmentation are: elimination of modifiable risk factors (smoking, varicocele, obesity), antioxidant therapy, short withdrawal period, use of donor oocytes in ART programs, as well as cell selection methods in ICSI programs and use of testicular spermatozoa obtained by testicular biopsy.