Tse-En Wang, Cheng-Teng Hsu
Worldwide, approximately 190 million individuals are affected by infertility, of which 50% are male factor infertility cases. Basic microscopic examination constitutes the first-line evaluation of male fertility potential; however, because of normal results on basic semen analysis, approximately 15% of infertile males are diagnosed with idiopathic infertility. Both European Association of Urology (EAU) guideline and World Health Organization (WHO) laboratory manual have broadened the ambit of the platform of semen analysis with a dedicated section on Sperm DNA Fragmentation (SDF), which has benefits in not only identifying the cause of male infertility but also improving the outcomes of Assisted Reproductive Technologies (ART). Although SDF is a promising index of male reproduction, some gaps hinder the broader application of SDF in routine clinical practice. In this review, we discuss the limitations of SDF and present an update of the clinical utilization of SDF based on emerging knowledge, which enables a recalculation of the possibility of SDF incorporation in routine semen analysis to reshape the future of male infertility diagnosis.