Predictors of elevated sperm DNA fragmentation: a morphology-based approach to semen analysis.

BACKGROUND: Empirical evidence indicates that high levels of sperm DNA fragmentation (SDF) negatively impact the results of both natural conception and assisted reproductive technology (ART). However, there is a notable absence of detailed guidelines for clinicians on which patient groups should be tested for SDF based on their semen analysis results. The goal of this study was to determine which sperm categorizations and morphological subcategorizations should be tested for sperm DNA integrity. RESULTS: Lowered sperm concentration, motility, progressive motility, and morphology, as well as a higher percentage of immature sperm, were linked to increased DNA Fragmentation Index (DFI) values. Higher DFI values were also found in semen samples from patients with two-sided varicoceles. The most significant intermediate correlation was identified between DFI and micro/partial head defects. Additionally, a low but significant correlation was observed in cases of combined oligo-astheno-teratozoospermia. CONCLUSION: Targeted DFI assessment is especially valuable for patients who have a two-sided varicocele, micro/partial head sperm defects, or combined oligo-astheno-teratozoospermia. Incorporating this assessment may enhance the diagnostic accuracy of male infertility evaluations.