Development of treatment strategies in men with vulnerable sperm

Ashok Agarwal, Chak-Lam Cho, Sandro C. Esteves, Ahmad Majzoub


Dr. Samplaski, in her commentary, elegantly discussed different issues surrounding sperm DNA fragmentation (SDF) (1) and the author largely endorsed the practice recommendations by Agarwal et al. (2). Firstly, she stated the drawbacks of routine semen analysis in the evaluation of male infertility supported by data from the LIFE study (3). This was followed by discussion of the testing methodologies. The author then further elaborated on interventions for mitigating high SDF and stressed on the use of antioxidant and testicular sperm as possible treatment strategies. Additional information on deleterious effects of cryopreservation on SDF was highlighted. Finally, the author summarized towards the end in last paragraph that “plan for an intracytoplasmic sperm injection (ICSI) cycle with a fresh testicular sperm extraction (TESE)/testicular sperm aspiration (TESA)” if SDF is persistently high even after correction of all reversible factors.