The role of sperm DNA fragmentation in reproduction: a SWOT analysis.

Background: Male factors account for up to 50% of infertility cases worldwide. Among the various etiologies, sperm DNA damage has received increasing attention through extensive research on sperm function tests. However, recommendations for its routine inclusion in infertility assessment remain unclear, and the clinical scenarios where such testing may be beneficial are still uncertain.

Objective: To evaluate the implications of sperm DNA damage testing and treatment in reproductive medicine.

Study design: A SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis was conducted to assess the screening and management of sperm DNA fragmentation (SDF) in infertile men. Evidence from the reviewed literature was graded according to Oxford criteria for clinical studies to ensure objectivity.

Results: SDF may contribute to certain cases of male infertility; however, reproductive outcomes are strongly influenced by additional factors, particularly oocyte quality and the method of conception. The absence of standardized cut-off values and low reproducibility across available assays represent major limitations. These weaknesses restrict the clinical utility of SDF testing, potentially increase healthcare costs, and may lead to inappropriate treatments.

Conclusion: SDF testing may provide insights into male infertility, but its clinical application is currently limited. Well-designed randomized controlled trials are needed to clarify its role and to establish evidence-based recommendations for its integration into assisted reproductive protocols.