Restoration of fertility potential via targeted treatment approach

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

Abstract

Dr. O’Flaherty, in his commentary in response to the practice recommendations by Agarwal et al. (1), illustrated two important points that are worth further discussion. Firstly, the author correctly pointed out the low success rate of using in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in bypassing male factor infertility. The negative impact of sperm DNA fragmentation (SDF) on reproductive outcomes was also highlighted and, more importantly, the safety of using poor quality sperm was questioned. Then, the author discussed the treatment strategies of high SDF and identified the shortcomings of current sperm selection procedures. Secondly, the authors described the underlying mechanisms of defective sperm DNA compaction in cancer patients (2).