Clinical scenarios of unexplained sperm DNA fragmentation and their management
The article by Agarwal et al. (1), reviews the currently available tests of sperm DNA fragmentation (SDF) and discusses their use in different clinical scenarios. Here, we intend to relate the use of SDF testing to different clinical histories of couples attending with infertility problems, and to suggest a sequence of therapeutical choices according to the severity of sperm damage and its evolution in response to previously applied treatments. Particular attention is paid to situations in which the cause of SDF is not known or in which sperm DNA integrity does not improve after appropriate treatment of the supposed causative factor, such as varicocele or chronic genitourinary infection.