How Do We Deal With Sperm DNA fragmentation? Are IVF programs Overlooking This?

Normal sperm DNA is essential for the healthy contribution of the father’s genes.

Tests which show an increased fraction of sperm DNA fragmentation has been shown in some studies to correlate to other sperm pathologies such as poor motility, count and morphology. However, due to lack of confirmatory evidence of its role in fertilization most reproductive endocrinology clinics do not test for sperm DNA fragmentation. Many state that they would perform IVF whenever the patient presents with even borderline sperm parameters and that the test therefore would not effect their management.

As in all areas of medicine, there is internecine battling going on between physicians as to the meaning and the effect of sperm DNA fragmentation on male fertility. Some doctors completely disagree with its relevancy as a contributor to male infertility; some physicians accept its contribution but don’t know what to do with the findings; others think that the only real detriment to the quality of sperm rendered by DNA fragmentation is the sperm’s inability to penetrate the egg and they think that injecting the sperm into the egg (ICSI) effectively deals with the problem. Unfortunately, there is evidence to the contrary.

Sperm DNA fragmentation has a far reaching effect on fertility and surpasses the mere diminished ability of sperm to penetrate egg.

Some studies show that with higher percentages of sperm DNA fragmentation, there are increased correlations in spontaneous abortions. The proportion of patients with abnormal sperm DNA integrity is higher in couples with spontaneous miscarriage. This is not surprising as a good embryo is nothing other than the combination of a good egg with a good sperm and sperm with DNA fragmentation is not good sperm. [1]

In sperm without DNA fragmentation the DNA is protected from damage while being transported through both the male and female reproductive tracts; if there is damage to the DNA then impaired fertility would logically follow.

Causes of DNA fragmentation are many and varied ranging from genetic anomalies to reactive oxygen species due to white blood cell (leukocyte) infiltration), as well as varicocoeles.

As DNA repair systems are less active in the later stages of sperm production, sperm with fragmented DNA can readily reach the ejaculate.

Men that have sperm DNA fragmentation greater than 30% are typically infertile

Treatment options

Antioxidant therapy

Antioxidants ‘scavenge’ reactive oxygen species and can, in some instances, reduce sperm DNA fragmentation percentages. An anti oxidant compound which has been shown to be effective in some instances is composed of lycopene 6mg, vitamin E 400IU, vitamin C 100mg, zinc 25mg, selenium 26 mg, folate .5 mg and garlic (available in pill form)1000 mg. This should be taken once daily.

Acupuncture and Herbs

Acupuncture with its ability to stimulate blood which transports oxygen and nutrients to the testes, while carrying debris away from the testes may also be an effective treatment.

Many herbal medicines also have high antioxidant properties and should be included in the treatment regimen.

Combining antioxidant therapy as described above with acupuncture and herbal medicine can potentially reduce sperm DNA fragmentation and increase fertility outcomes in men with high percentages of DNA fragmentation.

Smoking cigarettes and marijuana have been shown to contribute to sperm DNA fragmentation. Elimination of these mitigators may also reduce sperm DNA fragmentation.

Mike Berkley, L.Ac. Berkley Center for Reproductive Wellness and Woman's Health

References
[1] Schlegel, Peter N. Sperm Chromatin Abnormalities and Reproductive Outcome Biennial Review of Infertility, 2009; 129