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Sperm DNA Fragmentation Testing in the Era of Assisted Reproduction: Clinical Utility, Thresholds, and Management
Xiaodong Zhao1, Jianwen Wang1, Huabin Wang1
1Reproductive Medicine Center, The First Hospital of Lanzhou University, 730000 Lanzhou, Gansu, China.
Archivos Espanoles De Urologia
|May 9, 2026
Summary
Sperm DNA fragmentation (SDF) testing offers valuable insights beyond semen analysis for male infertility. Specific thresholds for TUNEL, SCSA, SCD, and Comet assays guide clinical decisions in reproductive medicine.
Area of Science:
- Reproductive Medicine
- Andrology
- Genetics
Background:
- Sperm DNA fragmentation (SDF) is a key biomarker in male infertility, providing information beyond standard semen analysis.
- Its inclusion in WHO guidelines highlights its clinical significance in reproductive health.
- Elevated SDF is linked to lower fertilization, poorer embryo quality, reduced pregnancy, and increased miscarriage rates.
Purpose of the Study:
- To review current SDF testing methodologies and their clinical applicability.
- To compare the technical characteristics, reproducibility, and predictive value of major SDF tests for assisted reproductive technology (ART) outcomes.
- To provide a practical, evidence-based framework for SDF testing and management.
Main Methods:
- Narrative review of current SDF testing methodologies.
- Comparison of four principal testing modalities: TUNEL, SCSA, SCD test, and Comet assay.
- Evaluation of technical characteristics, reproducibility, and ART outcome predictive value.
Main Results:
- Methodology-specific cut-off values offer clinical guidance: TUNEL (>16.8-20%), SCSA (>25%), SCD (15-25%), and alkaline Comet assay (>26%).
- Clinical indications include recurrent pregnancy loss, unexplained infertility, and recurrent ART failure.
- Management strategies include varicocelectomy, optimized abstinence, antioxidants, and testicular sperm extraction.
Conclusions:
- SDF testing is crucial for male infertility evaluation, especially with normal semen parameters.
- Methodology-specific thresholds aid in interpreting SDF results for ART.
- Management should integrate SDF findings with female factors and planned ART modality for optimal outcomes.
