April 27, 2020
Author Name: Dr.Chetan Ravindra Patil || Mentor Name: Dr. Kishor Kawad on April 27, 2020
About 15% of married couples worldwide experience fertility problems and about 50% of these cases are partially or completely caused by male factor infertility. Male factor infertility depends on multiple factors like physical characters of sperm like sperm count, motility, morphology, viability as well as on sperm DNA integrity i.e.nuclear structure of sperm.Physical characters of sperm can be evaluated by ‘routine semen analysis’,but there are some men in which routine semen analysis is absolutely normal still they are infertile because routine semen analysis does not tell us about nuclear structure of sperm.Sperm DNA damage can be evaluated by a special test called”SPERM DNA FRAGMENTATION”(SDF).
This refers to certain abnormal genetic material that may be present within the nucleus of the sperm which may be the one of the causes for not allowing the pregnancy to occur or in certain cases the pregnancy may also occur but may result in very early pregnancy loss for which no cause has been obtained.Infertile men generally have a greater extent of sperm DNA damage that means they are having more DNA fragmentation than fertile men. Sperm DNA fragmentation less than 25 is considered as normal and above 25 chances of pregnancy decreases accordingly. Sperm DNA fragmentation test is done by TUNEL assay,COMET assay and there are some spectroscopic assay.It is recommended that all infertile men either they are having normal semen parameters or abnormal semen parameters should undergo sperm DNA fragmentation test,because if detected early we can treat early and pregnancy can be achieved.
Lifestyle modification is the most important,simple and easy way to improve sperm quality.Physical agents such as cigarette smoke,airborne pollutants,heat and radiation,chemical agents such as anticancer drugs,biological factors such as increasing age,elevated body mass index and diabetes are environmental and lifestyle factors known to affect sperm DNA integrity.
Therefore men with fertility problems should undergo following lifestyle modifications..
2.Oral antioxidant therapy:-
Oxidative stress due to reactive oxygen species is known to be an important factor that cause male infertility by damaging sperm DNA.Many studies have found out that antioxidant plays an important role in reducing sperm DNA damage.
*Dietary antioxidant intake:-Increase intake of fruits and vegetables which are rich in antioxidants-spinach, papaya, pineapple, strawberries, oranges, cauliflower, kiwi, almonds, oats.
*Supplementary antioxidants:-Antioxidant therapy for reducing sperm DNA fragmentation has been tested in numerous trials and studies have found that vitamin C, vitamin E, zinc, selenium, coenzyme-Q10, N-acetylcysteine, lycopene, astaxanthin to be effective in reducing sperm DNA fragmentation.
Infection of the male genital organs can also cause sperm DNA damage because inflammatory cells produce reactive oxygen species which are known to cause DNA damage.So control of infection with antibiotic therapy also plays an important role in improving damaged sperm cells.
Varicocele is one of the most common cause of male infertility.Varicocele is caused by abnormal dilatation of pampiniform plexus veins which can increase testicular temperature.There is higher level of sperm DNA damage observed in patients with varicocele due to increased testicular temperature as well as due to elevated levels of reactive oxygen species.Surgical repair of varicocele is known to improve semen parameters.
5.Sperm selection techniques:-
There are few techniques which can select sperm with less DNA damage when performing IVF/ICSI.Some of these methods include density gradient centrifugation,electrophoretic sperm isolation using a cell sorter,sperm magnetic sorting and high magnification microscopy.
Many studies have found out that testicular sperm generally have three to five times lower proportion of DNA fragmentation than ejaculated sperm.So using testicular sperm instead of ejaculated sperm during IVF/icsi gives better outcome.
So in conclusion whenever male had normal semen reports and not able to conceive with all treatment modalities or have abnormal semen report then all such male should undergo Sperm DNA Fragmentation test and take treatment accordingly to become father with own sperm before it too late to required donor sperm.
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