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Sperm DNA fragmentation and infertility: a narrative review

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Abstract

Purpose

The purpose of this narrative review is to provide a practical understanding of sperm DNA fragmentation (SDF) in the management of male infertility.

Methods

A search for systematic reviews and meta-analyses (SRMA) on SDF between April 1st, 2018 and April 1st, 2023 was performed using PubMed and articles were selected as per their relevance to the topic. Guidelines from major societies were also reviewed. Three clinical cases are reported and discussed.

Results

The search initially identified 80 articles. We selected 13 SRMAs based on their relevance to the topic. Of the 13 SRMAs, 7 evaluated the effect of SDF on assisted reproductive technology (ART) outcomes and recurrent pregnancy loss, 3 studied the effect of varicocele repair on SDF, and 3 evaluated the role of SDF involving lifestyle and environmental health factors including body mass index and male factor treatment strategies.

Conclusion

Evidence suggests that increased SDF has a negative impact on natural pregnancy and ART outcomes. SDF testing may be particularly important in the infertility evaluation of men with varicoceles, idiopathic or unexplained infertility, recurrent pregnancy loss, or previous ART failure. Further studies are needed on SDF testing and the implications it can have on male factor infertility and pregnancy outcomes as well as its implementation in the setting of ART.

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Fig. 1

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Authors and Affiliations

  1. Department of Urology, Souss Massa University Hospital, Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco

    Imad Ziouziou

  2. Global Andrology Forum, Moreland Hills, OH, USA

    Imad Ziouziou, Amarnath Rambhatla & Ashok Agarwal

  3. Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA

    Amarnath Rambhatla & Rupin Shah

  4. Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India

    Rupin Shah

  5. Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

Authors
  1. Imad Ziouziou
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  2. Amarnath Rambhatla
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  3. Rupin Shah
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  4. Ashok Agarwal
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Contributions

IZ & AR: Data Collection, Data analysis, Manuscript writing. RS & AA: Project development, Manuscript editing.

Corresponding author

Correspondence to Ashok Agarwal.

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Ziouziou, I., Rambhatla, A., Shah, R. et al. Sperm DNA fragmentation and infertility: a narrative review. World J Urol 42, 408 (2024). https://doi.org/10.1007/s00345-024-05090-2

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