Sperm DNA Fragmentation and the Evaluation of Male Infertility

The procedure itself is not risky, but the implantation rate is only around 30 to 40%, which is why IVF success rates are not higher. Transferring more than one embryo to improve the pregnancy rate raises the chance of a multiple pregnancy, such as twins or triplets, well above the rate seen in natural conception. Placement technique also matters: pushing too much volume or placing an embryo too close to the fallopian tube raises the risk of an ectopic pregnancy, and in rare cases a heterotopic pregnancy can occur, where one embryo implants in the uterus and another develops in the tube, a complication seen almost exclusively with IVF.

A menopausal woman has no retrievable eggs of her own, but she can still conceive using a donor egg, which is a common and well-established approach even at a young age. After menopause the ovary is no longer producing estrogen, so hormones are given from outside to prepare the uterine lining, a donor egg is used, and the pregnancy proceeds and can be carried to delivery without issue.

It is used as a screening tool before starting any infertility treatment, whether ovulation induction, IUI or IVF, to know whether the woman carries an abnormal haemoglobin such as haemoglobin S or C, or is a thalassaemia carrier. If she is found to be a carrier, the male partner needs to be evaluated too, because of the inheritance risk: if both partners are thalassaemia minor carriers, for example, there is a 25% chance of a child being thalassaemia major. Couples in this situation may need genetic counselling or pre-implantation genetic testing, screening embryos for these conditions before transfer.

Sperm found in urine points to retrograde ejaculation, which usually follows a pelvic, perineal or urological surgery, or occasionally occurs in diabetes. Natural conception is not possible in this situation. The approach is to give the male partner an alkalinizing agent, then collect a urine sample immediately after ejaculation, centrifuge it and separate the sperm. Depending on the concentration recovered, those sperm can then be used for IUI or for IVF with ICSI. Any underlying epididymitis should be treated with antibiotics first, and the infection cleared, before using the sperm collected this way.

For oligospermia, the approach depends on how low the concentration is: a genetic evaluation including karyotyping and Y-chromosome microdeletion testing is warranted, alongside correcting modifiable lifestyle factors such as smoking and alcohol, and giving antioxidants. Because sperm production takes about 90 days from formation to transport, semen analysis should be repeated after 8 to 12 weeks. If genetics are normal and the count improves, IUI is reasonable; if not, assisted reproduction is the next step. For azoospermia, a full hormonal evaluation is needed to distinguish hypergonadotropic from hypogonadotropic causes. A hypogonadotropic pattern can often be managed medically with gonadotropins. A hypergonadotropic pattern means the testes themselves have failed, and the approach then is surgical sperm retrieval, such as TESA or micro-TESE, followed by ICSI.

DFI measures the extent of DNA damage inside sperm. A result below 15% suggests good fertility potential, 15 to 25% suggests reduced potential, and above 25% suggests poor fertility potential, and it can explain infertility even when a standard semen analysis looks normal.

Testing is reserved for selected cases: advanced male age, obesity, diabetes, smoking, varicocele, prior chemotherapy or radiation, unexplained infertility, or recurrent pregnancy loss.