Sperm DNA Fragmentation and Male Infertility: A Comprehensive Review
DOI:
https://doi.org/10.69968/ijisem.2025v4i2424-431Keywords:
Sperm DNA fragmentation, male infertility, oxidative stress, assisted reproduction, embryo qualityAbstract
Male infertility remains a critical concern in reproductive medicine, with sperm DNA fragmentation (SDF) emerging as a key factor in impaired fertility potential. This review compiles and critically examines current literature on the biological mechanisms, diagnostic approaches, and clinical significance of SDF. The paper explores how oxidative stress, apoptosis, and defective chromatin packaging contribute to DNA damage in sperm cells. Various diagnostic tools such as TUNEL, SCSA, Comet assay, and SCD test are reviewed in terms of reliability and clinical relevance. The role of SDF in natural conception, intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) is also discussed. Furthermore, the review addresses therapeutic interventions ranging from lifestyle modifications and antioxidant therapy to the application of advanced sperm selection techniques. It was observed that high levels of SDF are associated with lower fertilization rates, poor embryo quality, increased miscarriage risk, and reduced pregnancy outcomes. Recognizing and managing SDF could significantly enhance reproductive success and guide patient-specific fertility treatment.
References
[1] Graham KM, Kouba CK. Ultrasonography to assess female reproductive status and inform hormonally induced ovulation. Reproductive Technologies and Biobanking for the Conservation of Amphibians; Silla, A., Kouba, A., Heatwole, H., Eds. 2022 Oct 3.
[2] Oliva R. Protamines and male infertility. Human reproduction update. 2006 Jul; 12(4):417-35.https://doi.org/10.1093/humupd/dml009
[3] Barrett KE. Ganong's review of medical physiology. : McGraw Hill Education; 2019 Dec 29.
[4] Guyton AC, Hall JE. Guyton and Hall textbook of medical physiology. Elsevier; 2011.
[5] Agarwal A, Farkouh AA, Saleh R, Hamoda TA, Salvio G, Boitrelle F, Harraz AM, Abou Ghayda R, Kavoussi P, Gül M, Toprak T. Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility: a global survey, current guidelines, and expert recommendations. The world journal of men's health. 2024 Jan; 42(1):202.
[6] Busnelli A, Garolla A, Di Credico E, D'Ippolito S, Merola AM, Milardi D, Pontecorvi A, Scambia G, Di Simone N. Sperm DNA fragmentation and idiopathic recurrent pregnancy loss: results from a multicenter case-control study. Andrology. 2023 Nov; 11(8):1673-81.https://doi.org/10.1111/andr.13395
[7] Braga DP, Setti A, Morishima C, Provenza RR, Iaconelli Jr A, Borges Jr E. The effect of sperm DNA fragmentation on ICSI outcomes depending on oocyte quality. Andrology. 2023 Nov; 11(8):1682-93.https://doi.org/10.1111/andr.13435
[8] Du C, Tuo Y. Correlation of DNA fragments with routine semen parameters and lifestyle and their impact on assisted reproductive outcomes. Revista internacional de andrologia. 2023 Apr 1; 21(2):100337.https://doi.org/10.1016/j.androl.2022.03.001
[9] Zhang Z, Yu C, Chu Z, Heng BC, Tong G, Xia Y. The number of retrieved oocytes is correlated to sperm DNA fragmentation when predicting pregnancy outcomes. American Journal of Translational Research. 2023; 15(5):3759.
[10] Pozzi E, Fallara G, Belladelli F, Corsini C, Raffo M, Candela L, Schifano N, d'Arma A, Capogrosso P, Boeri L, Cilio S. Clinical parameters associated with altered sperm DNA fragmentation index among primary infertile men: Findings from a real‐life cross‐sectional study. Andrology. 2023 Nov; 11(8):1694-701.https://doi.org/10.1111/andr.13380
[11] Peng T, Liao C, Ye X, Chen Z, Li X, Lan Y, Fu X, An G. Machine learning-based clustering to identify the combined effect of the DNA fragmentation index and conventional semen parameters on in vitro fertilization outcomes. Reproductive Biology and Endocrinology. 2023 Mar 15; 21(1):26.https://doi.org/10.1186/s12958-023-01080-y
[12] Liang X, Duan R, Luo Q, Wu H, Si S, Mo G, Ji P, Liao Y. Number of Available Embryos: A Prediction Tool for Analyzing the Effect of Sperm DNA Fragmentation on Pregnancy Outcome of Patients Undergoing IVF Cycles from Embryology. Andrologia. 2023 Oct 25; 2023.https://doi.org/10.1155/2023/1921515
[13] Okubo T, Onda N, Hayashi T, Kobayashi T, Omi K, Segawa T. Performing a sperm DNA fragmentation test in addition to semen examination based on the WHO criteria can be a more accurate diagnosis of IVF outcomes. BMC urology. 2023 Apr 29; 23(1):78.https://doi.org/10.1186/s12894-023-01257-y
[14] Zhu C, Chen F, Zhang S, She H, Ju Y, Wen X, Yang C, Sun Y, Dong N, Xue T, Liu K. Influence of sperm DNA fragmentation on the clinical outcome of in vitro fertilization-embryo transfer (IVF-ET). Frontiers in Endocrinology. 2022 Jul 14; 13:945242.https://doi.org/10.3389/fendo.2022.945242
[15] Wang H, Li H, Zhu J, Xu J, Jiang Y, Chen W, Sun Y, Yang Q. The effect of sperm DNA fragmentation on in vitro fertilization outcomes for women with polycystic ovary syndrome. Frontiers in Endocrinology. 2022 May 27; 13:822786.https://doi.org/10.3389/fendo.2022.822786
[16] Repalle D, Saritha KV, Bhandari S. Sperm DNA fragmentation negatively influences the cumulative live birth rate in the intracytoplasmic sperm injection cycles of couples with unexplained infertility. Clinical and experimental reproductive medicine. 2022 Sep; 49(3):185.https://doi.org/10.5653/cerm.2021.05169
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