Table 1. Recommendations by Agarwal et al (2020) [18].

The following men should undergo SDF testing
	1. Men with unexplained or idiopathic male infertility (Grade C)
	2. Couples experiencing recurrent pregnancy loss (Grade C)
	3. Men with modifiable lifestyle risk factors (Grade C)
	4. Men with clinical varicocele (Grade C)
	5. Infertile couples prior to initiating or after failure of IUI or IVF (Grade C)
	6. Couples with recurrent miscarriage following ICSI (Grades B-C)
The following treatment approaches can lower SDF (Grade C)
	1. Oral antioxidant therapy
	2. Lifestyle modification, including diet modification and weight loss
	3. Recurrent ejaculation
	4. Control of infection and inflammation
Men with varicocele and high SDF should undergo varicocelectomy (Grades B-C)
Patients with persistently high SDF should be directed towards ICSI (Grade C)
Sperm processing and preparation or testicular sperm can be used for ICSI with recurrent miscarriage and high SDF (Grades B-C)

SDF: sperm DNA fragmentation, IUI: intrauterine insemination, IVF: in vitro fertilization, ICSI: intracytoplasmic sperm injection.