sperm DNA fragmentation
Women often get a hard go in life. We usually make less money than men, we often bear the work of running a household and working full-time and we take the blame for a lot of fertility issues.
Gosh, I hate the word “blame,” but you know what I mean. Women’s age is a major factor in a couple’s fertility. Eggs do not age well. Sperm don’t decline like eggs do with age, but still decline. With age, sperm fragmentation increases with age as well, making the sperm less likely to be able to fertilize an embryo or, if fertilization occurs, less likely to make a healthy embryo.
We do not routinely test for sperm DNA fragmentation at Olive as it has not correlated all that well with fertility. Also, as I often explain to patients who ask about sperm DNA fragmentation testing, the treatment for highly fragmented sperm is these oral antioxidant supplements and life style changes:
- N-acetyl cystine 600mg per day
- Omega/fish oil
- Coenzyme Q 10 300mh
- Multivitamin (because it contains vitamin E, C and zinc)
- Avoid: smoking, high trans-fat diet
- Minimize: SSRI dose/use
This is good advice to follow, no matter the DNA fragmentation.
A study published this month in Fertility and Sterility looked at the impact of high sperm DNA fragmentation and IVF outcomes. Interestingly, it does not impact IVF outcomes unless the woman’s age is > 40. The study found that when the woman’s age was over 40 there were significantly lower blastocyst development rates, lower pregnancy rates, and an increased miscarriage rate in IVF cycles with > 30% sperm DNA fragmentation compared with <30% fragmentation.
For women < 40 sperm DNA fragmentation did not matter.
With this knowledge there are two possible approaches:
- Test every male whose female partner is > 40 for sperm DNA fragmentation and treat with the above supplements and life style changes if it is abnormal.
- Treat every male whose female partner is > 40 with the above supplements and life style changes.
Sperm DNA fragmentation testing costs about $600 so I have tended to ask men to follow the above advice and not bother with the test. I say “if the test is abnormal this is the treatment but if the test is normal you likely should also do the treatment. So either way you should take the supplements and optimize your lifestyle.
Now, there are some men who would still benefit from testing sperm DNA fragmentation - ask your doctor if it makes sense for your unique situation.
Reference: Setti AS, Braga DPAF, Provenza RR, Iaconelli A Jr, Borges E Jr. Oocyte ability to repair sperm DNA fragmentation: the impact of maternal age on intracytoplasmic sperm injection outcomes. Fertil Steril. 2021 Jul;116(1):123-129.
Reproductive Endocrinology & Infertility