For a long time we have been able to assess a man's sperm quality by looking at the number of sperm, the effective motility of the sperm and the shape of the sperm to evaluate a man's fertility potential. But we now know that what we can see only tells us part of the story. In recent years a lot of attention has been paid to the presence or absence of DNA damage in the sperm of men whose partners are not succesful in reproducing even though the female partner's factors predict they should be successful.

An examination of the fragmentation of the DNA in the sperm can be evaluated by a test called Sperm Chromatin Sturcture Assay (SCSA). I have used this test in couples with no other reason for repeated early pregnancy loss and those who have not succeeded with IVF with unexplained poor embryo quality or when I expected success and couple did not achieve it. When we find a high degree of fragmantation the options include life style changes and antioxidant vitamins (about which RPMG's Dr. David Meldrum has written extensively in his Lifestyle & Fertility page on our website) or obtaining immature sperm by testicular biopsy (TESE) before the DNA fragments as the sperm goes through the maturation process. The immature sperm can be used in intracytoplasmic sperm injection (ICSI). In the March 2010 issue of Fertility & Sterility a study confirms that in men with high DNA fragmentation and who have failed antioxidant treatment, ejaculated sperm showed a threefold higher DNA damage when compared with testicular samples (39.7% vs. 13.3%).

I have had a number of couples in which this strategy has worked well. it is something to be considered in IVF failure for no apparent reason or unexpected poor embryo quality or in couples with recurrent pregnancy loss without a documented cause.