Editing Infertility: Diagnosis and Evaluation (section)

===== DNA fragmentation =====
* Negatively associated with pregnancy rates and positively associated with miscarriages
**Patients with high sperm DNA fragmentation can be counseled that there is a possible association with infertility and compromised outcome after ART
*'''Direct measures of sperm DNA fragmentation include (2):'''
**Terminal deoxynucleotidyl transferase dUTP nick end labeling '''(TUNEL) assay'''
**'''Comet assay'''
* '''<span style="color:#ff0000">Indications</span>'''
**'''<span style="color:#ff0000">Not recommended in the initial evaluation of the infertile couple</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
**May be useful in couples undergoing IVF with repeated IVF failure
*Management
**Currently no effective therapy to correct an abnormal DNA fragmentation result
**If high sperm DNA fragmentation, consider'''[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
***Using surgically obtained sperm in addition to ICSI
****In a prospective cohort study of over 100 couples with high DNA fragmentation, testicular sperm yielded substantially higher live birth rates than ejaculated sperm.[https://pubmed.ncbi.nlm.nih.gov/28865546/]
***Antioxidant administration
***Varicocele repair
***Frequent ejaculation
****Decreased abstinence may be an intervention to limit sperm DNA damage.[https://pubmed.ncbi.nlm.nih.gov/29043697/]
***Donor sperm