Using sperm testing to improve patient and offspring health: rational, evidence-based care of the infertile male in the ART clinic

Douglas T. Carrell, James Hotaling


In the modern world of infertility care, two realities facing most clinicians are the basic fact that in many situations limited financial resources are available to address the couple’s infertility, and second, couples desire to treat their infertility as quickly as possible (1). These factors have unfortunately justified in the minds of many clinicians the rush to the assisted reproduction therapy (ART) clinic and treatment with intracytoplasmic sperm injection (ICSI), rather than traversing the morass of sperm assays with limited standardization and validated performance characteristics and usage guidelines (2,3). While the discovery of ICSI is undoubtedly the most useful development in infertility care since the introduction of in vitro fertilization (IVF), it has also unfortunately contributed to the decrease in efforts to accurately diagnose underlying etiologies and medically and surgically address the etiologies (4, 5). In the review by Agarwal et al., we have a measured, rational explanation of the differences in sperm DNA damage assays, as well as a concise review of the data regarding medical and surgical intervention in patients with sperm DNA fragmentation (6).