Table 1. Clinical practice guidelines for SDF testing and indications for sperm DNA testing.
| SDF tests |
| Neat semen sample should be used for SDF testing (grade C recommendation) |
| A fixed ejaculatory abstinence before collection of semen sample should be applied (grade C recommendation) |
| A standardized protocol with stringent quality control is essential for a reliable SDF testing result (grade B–C recommendation) |
| SDF threshold reflects the probability on reproductive outcome (grade B–C recommendation) |
| Indications for SDF testing |
| Clinical varicocele |
| SDF testing is recommended in patients with grade 2/3 varicocele with normal conventional semen parameters (grade C recommendation) |
| SDF testing is recommended in patients with grade 1 varicocele with borderline/abnormal conventional semen parameter results (grade C recommendation) |
| Unexplained infertility/IUI failure/RPL |
| SDF testing should be offered to infertile couples with RPL or prior to initiating IUI (grade C recommendation) |
| Early IVF or ICSI may be an alternative to infertile couple with RPL or failed IUI (grade C recommendation) |
| IVF and/or ICSI failure |
| SDF testing is indicated in patients with recurrent failure of assisted reproduction (grade C recommendation) |
| The use of testicular sperm rather than ejaculated sperm may be beneficial in men with oligozoospermia, high SDF and recurrent IVF failure (grade B–C recommendation) |
| Borderline abnormal (or normal) semen parameters with risk factor |
| SDF testing should be offered to patients who have a modifiable lifestyle risk factor of male infertility (grade C recommendation) |
Grades of recommendations according to quality of evidence: Grade A, based on clinical studies of good quality and consistency with at least one randomized trial; Grade B, based on well-designed studies (prospective, cohort) but without good randomised clinical trials; Grade C, based on poorer quality studies (retrospective, case series, expert opinion). Modified from Oxford Centre for Evidence-Based Medicine (http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/). SDF, sperm DNA fragmentation; IUI, intrauterine insemination; RPL, recurrent pregnancy loss; IVF, in-vitro fertilization; ICSI, intracytoplasmic sperm injection.