Diagnosis of Oxidative Stress / Sperm DNA Damage: What Clinicians Should Know Prior to ART

A chronic state of oxidative Stress (OS) impacting the male reproductivetract is believed to be the primary cause of poor semenparameters and compromised sperm DNA integrity. In turn, poorsperm DNA integrity or sperm DNA damage is strongly associatedwith poor conception rates, increased incidence of miscarriageand the health of the next generation. As a result, the developmentof diagnostic assays for the direct or indirect detection ofOS has gained much attention over the last two decades. Despitethe commercialization of several such assays, only a few percentof ART couples are evaluated for OS or sperm DNA damagein the USA. The main reasons are; ۱. many clinicians do notbelieve that sperm DNA damage is significantly consequentialand therefore view such tests as “expensive add-ons”, ۲. manyclinicians require unequivocal clinical validation of the tests topredict pregnancy, ۳. lab to lab testing variability and lack of reproducibility,۴. uncertainty over which test to use and finally and۵. unclear treatment protocol for men diagnosed with moderate tosevere sperm DNA damage.Following advancements in the field, the recent ESHRE policyguidelines now recommends testing for sperm DNA fragmentation,albeit limited to patients presenting with recurrent pregnancyloss. This short presentation aims to highlight the importanceof assessing sperm DNA integrity as a matter of routinefor all patients prior to treatment by ART.