Sperm DNA fragmentation testing in patients with subclinical varicocele: is there any evidence?

Ahmad Majzoub, Ashok Agarwal, Sandro C. Esteves


The commentary by Drs. Herati and Lamb towards the clinical utility of sperm DNA fragmentation (SDF) testing article by Agarwal et al. (1) offers valuable views enriching the debate on this subject. The authors recognized the drawbacks of the conventional semen analysis results in accurately predicting the true male fertility potential, and acknowledged the value that sperm function tests, like SDF, might offer in this regards. As for its applicability in varicocele patients, the authors went further proposing the utilization of SDF in patients with subclinical varicocele to help in selecting men who will ultimately benefit from varicocelectomy. Finally, they highlighted the recommendations of the American Society for Reproductive Medicine (ASRM) (2) suggesting that due to “…SDF testing’s low predictive ability of pregnancy outcomes, lack of validation between studies, and overall insufficient evidence correlating sperm DNA integrity and reproductive outcomes.” , caution should be practiced before utilizing this test for assisted reproductive treatments (ART).