Table 3. Indications for sperm DNA testing and its evidence.
| Indications | References |
|---|---|
| Varicocele | |
| Significant association between SDF and varicocele has been detected | Zini and Dohle (59); Wang et al. (60); Esteves et al. (61); Smith et al. (62) |
| Varicocelectomy improves percentage of SDF resulting in improved pregnancy rates | Zini and Dohle (59); Smit et al (63); Ni et al. (64) |
| Little is known about the effect of low grade varicocele on SDF. High SDF has been reported in clinical varicocele, particularly grade 2 and 3; improvement of SDF in all grades of varicocele have been reported after varicocelectomy | Ni et al. (64); Sadek et al. (67); Krishna Reddy et al. (68) |
| Unexplained infertility | |
| High SDF is found in men with normal semen parameters | Bungum et al. (19); Olezczuk et al. (71); Vandekerckhove et al. (72) |
| SDF is an independent predictor of male fertility status | Bungum et al. (73); Olezczuk et al. (71) |
| SDF levels can predict the likelihood of natural pregnancy | Zini (74); Buck Louis et al. (75); Spanò et al. (51) |
| Recurrent IUI failure | |
| High SDF is associated with lower IUI pregnancy rates | Bungum et al. (73); Duran et al. (76); Rilcheva et al. (77) |
| Recurrent pregnancy loss | |
| High SDF is associated with greater incidence of abortion | Khadem et al. (78); Bareh et al. (79); Zidi-Jrad et al. (80); Kumar et al. (81); Carlini et al. (82) |
| IVF and ICSI failure | |
| SDF modestly affect IVF pregnancy rates | Jin et al. (83); Zini and Sigman (84); Osman et al. (85) |
| SDF does not affect ICSI pregnancy rates | Zini and Sigman (84); Zhao et al. (86) |
| Higher live birth rate is observed in men with low SDF | Osman et al. (85); Bungum et al. (87) |
| High SDF is associated with greater incidence of abortion in both IVF and ICSI | Zini and Sigman (84); Robinson et al. (88) |
| Testicular sperm have lower SDF than ejaculated sperm | Esteves et al. (89); Moskovstev et al. (90); Greco et al. (91) |
| Higher IVF/ICSI success rates with testicular sperm | Bradley et al. (92); Esteves et al. (89); Greco et al. (91); Pabuccu et al. (93) |
| Lifestyle risk factors | |
| Modifiable lifestyle risk factors, including smoking and obesity, have detrimental effect on SDF | Sun et al. (12); Elshal et al. (94); Ramlau-Hansen et al. (95); Kort et al. (96) |
| The use of oral antioxidant is effectively in reducing SDF | Showell et al. (97) |
SDF, sperm DNA fragmentation; IUI, intrauterine insemination; IVF, in-vitro fertilization; ICSI, intracytoplasmic sperm injection.