Semen analysis (SA) vs. sperm DNA fragmentation
If you are new to fertility treatments, you, or your partner, most likely did a semen analysis. This test looks at total count, morphology (shape) and motility (movement) of the sperm. These factors are used to then make a treatment recommendation, typically for IUI or IVF.
A semen analysis only measures the visible characteristics of the sperm. The genetics, or DNA, of sperm is not measurable, and therefore can’t be understood, unless a separate sperm DNA fragmentation test is done. This test labels the quality of the sperm as ‘good’, ‘fair’, or ‘poor’.
What we can learn from Sperm DNA Fragmentation
Assuming there is no female infertility and nothing is flagged on a semen analysis, men in the ‘good’ range tend to contribute to the formation of healthier embryos. In these cases, there are lower rates of miscarriage and higher rates of live births.
Men who fall in the ‘fair’ and ‘poor’ range tend to have more fertility challenges. These couples can experience difficulty conceiving naturally, may routinely miscarry, and there can be high attrition rates with IVF cycles due to affected early embryonic development. https://academic.oup.com/humrep/article/29/11/2402/2427829.
High sperm DNA fragmentation – a silent infertility problem
I can’t tell you how many couples I’ve seen who have experienced multiple, unfavorable IVF attempts and their fertility doctor never ordered a sperm defragmentation test along the way. Or, I’ll often hear their doctor said something like, “it’s unnecessary because IVF is indicated regardless of test results, and we will do genetic testing on the embryos anyway.”
I will say if there is any suspicion that male factor could be contributing to poor embryo quality and/or high embryo attrition rates, a sperm DNA fragmentation test should be done before proceeding with another round of IVF, and certainly before transitioning to donor eggs.
For one thing, while sperm DNA can be tested, egg DNA cannot. Plus, sperm is much easier to gather than eggs.
I’ve seen too many couples move on to donor eggs only to find male factor contributed significantly to the problem. After all, donor sperm is less expensive, and a much less invasive option.
The importance of evaluating sperm health sooner in the IVF process
Male DNA impacts early embryonic development. Early embryonic development is typically the first 24 hours after fertilization. Embryos need to have developed roughly to five days old in order to be ‘old enough’ to make it to pre-genetic diagnosis (PGD) testing. If embryos don’t survive past day 3, there will be nothing to test, and often another round of IVF is inevitably recommended.
Hence, understanding sperm quality can really shed some light on a couple’s case before the IVF process even starts. Too often, it is assumed that the “problem” is an egg quality issue when the sperm hasn’t even been fully evaluated. The couple will be less persuaded/convinced that the ‘problem’ is more of an egg quality issue. Also, the importance of dietary and lifestyle recommendations can be emphasized if the couple decides to move forward with their own sperm, and not a donor.
Understanding dietary and lifestyle habits can really shed some light on sperm quality, as well. A recent study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2758861 showed the benefits of omega-3 fish oil on male testicular function and fertility. Our current conventional fertility medical model is backwards. Instead of providing insight into sperm health and then offering nutritional advice to improve male fertility, the semen analysis serves to dictate if/when IVF should be used with no mention of a sperm DNA fragmentation test.
Sharing the emotional burden
Given that sperm is easy to gather, and sperm DNA can be tested, why isn’t a DNA fragmentation test routinely done? Women must undergo routine bloodwork and ultrasounds along with diagnostic tests, including a sonohysterogram and a hysterosalpingogram, to assess anatomical barriers to conceiving. This seems backwards and expensive.
Testing men earlier on could not only shorten the infertility treatment timeline, but it could also help reframe the infertility struggle as more of a couple’s issue instead of primarily a woman’s issue. This can help women feel less isolated and could have far-reaching benefits in supporting the emotional health of the couple during the journey.