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(>30%), the obvious question for the patient and doctor is: what is the next step? Fix the problem or consider using IVF/ICSI, or use donor sperm?


1. The overall hypothesis on what causes sperm DNA fragmentation is oxidative (ROS) stress. Therefore, many physicians will not only advise a patient to eat a diet rich in antioxidants but may also advise to take nutritional antioxidant supplements. Since it takes about three months to make a mature sperm, the advice is to take it for three to six months and then determine if the level of sperm DNA damage is reduced. This works for some, but not all men, as the damage from oxidative stress is related to many factors, including the man’s own genetic make up.


2. If the %DFI is high and a high grade varicocele is present, the varicocele can be repaired by a physician. Two publications have shown that high levels (> 30%DFI) are reduced to levels below the threshold for infertility risk5 an increased pregnancy rate6


REFERENCES


1. Sakkas D and Alvarez J G (2010) Sperm DNA fragmentation: mechanisms of origin, impact on reproductive outcome, and analysis. Fertil Steril 93:1027-36


2. Zini A, Boman JM, Belzile E (2008) Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis. Hum Reprod. 23:2663–2668


3 Evenson DP and Wixon R (2006) Clinical aspects of sperm DNA fragmentation detection and male infertility. Therio 65:979-91


4. Rubes J, Selevan SG, Evenson D P, Zudova, D, Vozdova, M, Zudova, Z, Robbins, W A, Perreault, S D (2005) Episodic Air Pollution is Associated with Increased DNA Fragmentation in Human Sperm without other Changes in Semen Quality. Hum Reprod 20:2776-83


5. Sailer, BL, Sarkar, LJ, Jost, LK, Bjordahl, J and Evenson, DP (1997) Effects of heat stress on mouse testicular cells and sperm chromatin structure as measured by flow cytometry. J Androl 18:294-301


6. Smit M et al. (2010) Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate J Urology 183: 270-74


7. Werthman P, Wixon R, Kasperson K, Evenson DP (2008) Significant decrease in sperm deoxyribonucleic acid fragmentation after varicocelectomy. Fertil Steril 90:1800-4


8. Evenson, DP, Jost, LK, Corzett, M and Balhorn R (2000) Characteristics of human sperm chromatin structure following an episode of influenza and high fever: a case study. J. Androl. 21: 739-46


9. Wyrobek, AJ, Eskenazi, B, Young, S, Arnheim, N, Tiemann-Boege, I, Jabs, EW, Glaser, RL, Pearson, F, Evenson D (2006)Advancing age in healthy men has differential effects on DNA strand damage, chromatin integrity, gene mutations, aneuploidies and diploidies in sperm. Proc. Natl. Acad. Sci.USA. 2006 Jun 20; 103: 9601-6


10. P Romerius, O Ståhl, C Moëll, T Relander, E Cavallin-Ståhl, H Gustafsson, K Löfvander Thapper, M Spanò, K Jepson, T Wiebe, Y Lundberg Giwercman, A Giwercman (2010) Sperm DNA Integrity in Men Treated for Childhood Cancer. Clinical Cancer Research Int J Androl. 2010 Mar 16. [Epub ahead of print]


and in one of the studies .


3. Lifestyle factors can have a great effect on sperm DNA fragmentation including excessive smoking, drinking, obesity, hot tub/baths, stress, and use of some medications, e.g., cortisone3


.


4. Be aware that a man who conceived children in his 20s is likely not to be as fertile in his 50s. Young men in their 20s typically have a background of 3-5% DFI, but there is about a 1/3 chance that a man at age 50 will have a %DFI of about 30%, which is at an approximate clinical threshold9


.


SUMMARY: Current data suggest that it would be prudent for many patients to have a sperm DNA fragmentation test early in their journey to achieving a pregnancy, especially considering that at least 40% of couple infertility is due to male factor and a significant part of that group having high levels of sperm DNA fragmentation, not detectable by a semen analysis.


11. Tanrikut C, Feldman AS, Altemus M, Paduch DA, Schlegel PN (2009) Adverse effect of paroxetine (SSRI) on sperm Fertil Steril. Jun 10 [Epub ahead of print]


12. De Iuliis GN, Thomson LK, Mitchell LA, Finnie JM, Koppers AJ, Hedges A, Nixon B, Aitken RJ (2009) Biol Reprod. 3:517-24


13. Desai N, Sabanegh E Jr, Kim T, Agarwal A. (2010) Free Radical Theory of Aging: Implications in Male Infertility. Urology 75:14-19


14. P Werthman, R Boostanfar, W Chang, K Chung, H Danzer, T Koopersmith, G Ringler, M Shamonki, M Surrey, M Vermesh, J Wilcox. (2010) Use of Testicular Sperm/Intracytoplasmic Sperm Injection Yields High Pregnancy Rates in Couples who Failed Multiple In Vitro Fertilization Cycles Owing to High Levels of Sperm DNA Fragmentation. 2010 Pacific Coast Reproductive Society Abstract


15. Virro, MR, Larson-Cook, KL and Evenson, DP (2004) Sperm chromatin structure assay (SCSA®


spontaneous abortion in IVF and ICSI cycles. Fertility and Sterility 81:1289-95


16. Henkel R, Kierspel E, Hajimohammad M, Stalf T, Hoogendijk C, Mehnert C, Menkveld R, Schill WB, Kruger TF. 2003 DNA fragmentation of spermatozoa and assisted reproduction technology. Reprod Biomed Online 7:477-84


17. Enciso M, Sarasa J, Agarwal A, Fernández JL, Gosálvez J. (2009) A two-tailed comet assay for assessing DNA damage in spermatozoa. Reprod Biomed Online. 218:609-16


18. Evenson,DP, Darzynkiewicz, Z and Melamed, MR (1980) Relation of mammalian sperm chromatin heterogeneity to fertility. Science 240:1131-33


19. Evenson, DP, Jost, LK, Zinaman, MJ, Clegg, E, Purvis, K, de Angelis, P and Clausen, OP (1999) Utility of the sperm chromatin structure assay (SCSA) as a diagnostic and prognostic tool in the human fertility clinic. Human Reproduction 14:1039-49


20. Spanò et al., 2000. Spanò M, Bonde JP, Hjøllund HI, et al. Sperm chromatin damage impairs human fertility.(2000) The Danish First Pregnancy Planner Study Team. Fertil. Steril. 73:43–50


21. Giwercman A, Lindstedt L, Larsson M, Bungum M, Spano M, Levine RJ, Rylander L (2009) Sperm chromatin structure assay as an independent predictor of fertility in vivo: a case-control study Int J Androl. [Epub ahead of print Oct 15]


22. Bungum M, Humaidan P, Spanò M, et al. (2004) The predictive value of sperm chromatin structure assay (SCSA) parameters for the outcome of intrauterine insemination, IVF and ICSI. Hum. Reprod.19:1401–08


23. Zini A, Boman J M, Belzile E, Ciampi A. (2008) Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and metaanalysys. Hum Reprod 23:2663-68


24. Carrell DT, Liu L, Peterson CM, Jones KP, Hatasaka HH, Erickson L, et al (2003) Sperm DNA fragmentation is increased in couples with unexplained recurrent pregnancy loss. Arch Androl: 49:49–55


) related to blastocyst rate, pregnancy rate and


THE RESOURCES LISTED IN THIS DIRECTORY ARE UNSCREENED AND SHOULD NOT BE VIEWED AS RECOMMENDATIONS OR ENDORSEMENTS, EITHER EXPRESS OR IMPLIED, BY THE AFA. 66


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