Infertility topics explained by Brian Acacio, M.D.. www.AcacioFertility.com
Acacio Fertility Center, southern California. (949)249-9200 begin_of_the_skype_highlighting (949)249-9200 end_of_the_skype_highlighting
There appears to be a threshold of sperm DNA damage (fragmentation) beyond which embryo development and pregnancy are impaired. Fertile men with normal sperm parameters almost uniformly have low levels of DNA breakage, whereas infertile men, especially those with abnormal semen parameters, have increased DNA damage. Moreover, up to 8% of infertile men will have abnormal DNA integrity despite normal semen parameters.
The etiology of sperm DNA damage, much like male factor infertility, appears to be multifactorial and may be due to intrinsic or external factors. Intrinsic factors include protamine deficiency, mutations that affect DNA compaction, and advanced paternal age. High levels of reactive oxygen species (ROS’) are detected in the semen of 25% of infertile men, and sperm DNA damage has been associated with high levels of semen reactive oxygen species. External factors such as heat, chemotherapy, radiation, and others are associated with an increase in DNA damage. Cigarette smoking, genital tract inflammation, varicoceles, and hormonal deficiencies have all been associated with increased DNA damage.
In addition to infertility, men with abnormally high DNA fragmentation are more likely to result in recurrent miscarriages.
Treatments for elevated sperm DNA fragmentation include: Avoidance of toxicities such as smoking, hot tubs/saunas, etc. Antioxidant vitamin supplements may reduce sperm DNA damage (we have published reports of this benefit). Treatment of infection may reduce sperm DNA damage. Varicolectomy may reduce sperm damage. TESE (testicular extraction of sperm) has been proposed as being beneficial (we recommend it in some cases).
In my opinion, there appears to be increasing evidence of the benefits for both testing and treating for this condition.
Based on publication from the Practice Committee of the American Society for Reproductive Medicine (ASRM) 11/2008