Fig. 1.

Flow chart depicting the treatment algorithm based on sperm chromatin integrity for couples with unexplained infertility. When couples with unexplained infertility failed to achieve pregnancy with IUI, the male partner is screened for chromatin integrity to assess SDF. Those with SDF below threshold are advised to undergo standard in vitro insemination. Couples with high DNA fragmentation in the ejaculate, instead were treated directly by ICSI. This option would also be available to couples that failed standard IVF. Couples with persistent SDF in their ejaculate and that failed ICSI were offered to undergo surgical sperm retrieval in their subsequent ICSI cycle