Accumulating evidence has highlighted the contribution of oxidative stress and sperm DNA fragmentation (SDF) in the pathophysiology of male infertility. SDF has emerged as a novel biomarker of risk stratification for patients undergoing assisted reproductive technologies. Studies have also supported the use of testicular over ejaculated sperm at the time of intracytoplasmic sperm injection, as testicular sperm may have lower SDF than ejaculated samples. The European Association of Urology Working Panel on Male Sexual and Reproductive Health provides an evidence-based consultation guide on the indications for SDF testing in male infertility and also for testicular sperm extraction (TESE) in nonazoospermic men. We present the limitations and advantages of SDF testing and a framework to ensure that it is appropriately utilised in clinical practice. Furthermore, we critically appraise the current literature advocating the use of TESE in nonazoospermic men. PATIENT SUMMARY: This article reviews the evidence supporting the use of sperm DNA fragmentation testing in the assessment of male infertility and testicular sperm extraction in nonazoospermic men.
European urology focus. 2021 Jan 06 [Epub ahead of print]
Tharu Tharakan, Carlo Bettocchi, Joana Carvalho, Giovanni Corona, Thomas Hugh Jones, Ates Kadioglu, Juan I Martínez Salamanca, Ege Can Serefoglu, Paolo Verze, Andrea Salonia, Suks Minhas, EAU Working Panel on Male Sexual Reproductive Health
Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, UK; Section of Investigative Medicine, Department of Medicine, Imperial College London, London, UK., Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Centre for Psychology, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal., Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy., Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK., Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey., Department of Urology, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain., Department of Urology, Biruni University School of Medicine, Istanbul, Turkey; Department of Histology & Embryology, Medipol University School of Medicine, Istanbul, Turkey., Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy., Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy., Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, UK. Electronic address: .