DNA Fragmentation: The Complete Guide

Take-home points

• DNA fragmentation is an important factor to consider when trying to conceive, either as a pre-conception reassurance checkor or as part of IVF preparation.
• However, it is crucial to investigate further to determine the causes of DNA fragmentation and seek appropriate medical advice.
• Further medical investigations, guided by an experienced Andrologist, are essential in addressing this issue and improving the chances of successful conception and pregnancy.

Interest in DNA fragmentation is growing

Over the past two decades, there has been a growing interest in sperm DNA fragmentation in the field of andrology. More couples are now aware of this issue and want to know if it could affect their chances of conception. However, the information and availability of testing for DNA fragmentation are still inconsistent.

In 2021, the World Health Organization (WHO) published the sixth edition of its guidance on semen analysis testing and processing, which included more detailed recommendations for the use of DNA fragmentation testing.¹ Despite this, there have been no significant changes in the UK regarding the adoption of these recommendations.

What is DNA fragmentation?

DNA fragmentation refers to the damage that occurs to the DNA in the head of the sperm. This damage can involve breaks in the strands that connect DNA molecules together, and the more breaks there are, the lower the chances of successful conception and pregnancy.¹ The genetic blueprint of the sperm plays a crucial role in fertilization and the development of a healthy baby. If the DNA is damaged, it is unlikely that conception will occur, regardless of other factors.

DNA fragmentation test: A more accurate method to measure sperm health?

Semen analysis is a standard test offered to men who are trying to conceive, but it provides limited information about the integrity and genetic quality of sperm. It primarily assesses sperm count, motility, and morphology, without evaluating the genetic health of the sperm.¹ On the other hand, a sperm DNA fragmentation test provides a more comprehensive picture of sperm health and genetic quality.

How does DNA fragmentation affect pregnancy?

There are certain indications that DNA fragmentation is playing a role in a couple's chances of conceiving. These include repeated failure during in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) cycles, suboptimal sperm quality despite a healthy lifestyle, recurrent miscarriage, unexplained infertility after two years of trying to conceive, and symptoms such as testicular aching or heaviness.² It's important to note that DNA fragmentation can be present even if a man's semen analysis appears normal.

What causes DNA fragmentation in sperm?

DNA fragmentation is often caused by other factors that induce high oxidative stress in the body or sperm. Sperm are particularly vulnerable to heat and oxidative stress, which disrupts the balance between free radicals and antioxidants, ultimately affecting sperm quality. Some common causes of DNA fragmentation include varicocele, infections, and lifestyle and dietary factors.²

Where to find a DNA fragmentation test?

Currently, DNA fragmentation testing is not widely available, and it may take time for this to change. While the latest WHO guidance recommends DNA fragmentation testing, it is not offered as a standard test.¹ Private clinics, particularly those specializing in fertility treatments like IVF, may offer this test.

If high levels of DNA fragmentation are detected, it is important to seek guidance from a healthcare professional who specializes in male reproductive health, such as an Andrologist. They can help interpret the test results and investigate the underlying causes of DNA fragmentation through further tests. Once the causes are identified, potential treatment options can be explored. Lifestyle modifications, stress management, and appropriate medical interventions can help address DNA fragmentation.

Find out more about testhim and how they are raising awareness of fertility in men

TRTed is not financially supported by testhim in any capacity. testhim have a number of resources on their website to support men with infertility. If you have any questions, please don't hesitate to reach out to us at info@trted.org.

References:

1. WHO laboratory manual for the examination and processing of human semen, sixth edition. Geneva: World HealthOrganization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
2. Coughlan C, et al. Asian J Androl 2015;17(4):681–685.