The American Urology Association (AUA) and the American Society of Reproductive Medicine (ASRM) recommend at least two semen analyses in the initial evaluation of the infertile male. However, a normal semen analysis does not necessarily indicate successful male fertility; indeed, there is great overlap in semen analysis results between fertile and infertile men. There exists an opportunity for new variables and diagnostic tests with greater sensitivity in diagnosing infertility factors, with the ultimate goal being targeted treatments to facilitate successful conception and live birth. Sperm DNA integrity assays have gained popularity as a possible tool to identify infertility. Measured as sperm DNA fragmentation (SDF), it is not currently recommended in the routine work-up for the infertile male, neither by the ASRM, the AUA, nor the European Society for Human Reproduction and Embryology (ESHRE).
Varicocele, while prevalent in only 15% in the general male population, is much more common in infertile couples with male factor infertility (25–40%). As interest in SDF has grown, so has its application within the varicocele population. In this chapter, we will review the literature and discuss the lack of support for routine SDF testing in men with male factor infertility and varicocele.
Sperm DNA fragmentation Varicocele repair Varicocelectomy Oxidative stress
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