Sperm DNA fragmentation: laboratory and clinical aspects

Ahmad Majzoub, Ashok Agarwal, Sandro C. Esteves


The commentary by Drs. Khalili and Agha-Rahimi on the sperm DNA fragmentation (SDF) clinical guideline article by Agarwal et al. (1) recognized the presence of a negative association between high seminal SDF levels and fertility outcome specifically with assisted reproductive techniques (ART). Moreover, they have raised important concerns related to the lack of standardized SDF cutoff values and the influence of sperm preparation techniques during the course of ART on SDF levels. Furthermore, they brought into question, the exact treatment strategies that can be used for patients with high SDF. We certainly agree with these concerns which deserve further elaboration as seen below.