Treatment of infertility associated with a high level of sperm DNA fragmentation

Introduction. Damage of the sperm genetic material is one of the causes of male infertility, miscarriage and adverse ART outcomes. Treatment of patients with an increased level of sperm DNA fragmentation is a difficult task due to extremely limited number of treatment options. In this survey, we analyzed the available data on treatments of infertility associated with a high level of sperm DNA fragmentation. Materials and methods. Search, analysis and systematization of publications in the PubMed and e-Library databases using the keywords «male infertility», «sperm DNA fragmentation», «sperm DNA damage», «treatment», «IVF», «ICSI». We selected 83 sources that were included in this literature review. Results. In 13 studies the role of lifestyle modification, in 11 - the value of antioxidant and metabolic therapy, in 16 - the effectiveness of surgical treatment of varicocele, in 4 - the role of the treatment of genital infection and inflammation, in 1 - the effect of hormone therapy was evaluated. In 22 papers, the results of ART in the fragmentation of sperm DNA were evaluated. Surgical treatment of clinically significant varicocele is the most effective and confirmed method of reducing the level of sperm DNA fragmentation. The role of the surgical treatment of subclinical varicocele in those patients is underpresented in the literature. Antioxidant supplementation therapy is a promising method however the heterogeneity of studies hampers their comparison and its practical usage. Lifestyle modification seems to be the simplest way to reduce the level of sperm, but to date there is little evidence on the effectiveness of this approach. Few studies focus on the role of recombinant FSH therapy as well as treatment of accessory gonadal infections. A high level of fragmentation has a negative impact on the effectiveness of all ART techniques; nevertheless, ICSI is the preferred method for overcoming infertility associated with a high level of sperm DNA fragmentation. ICSI with testicular spermatozoa is a promising method, however, due to its invasiveness and it should be used only in the absence of success from other methods. Conclusion. Currently there is a shortage of treatment options for the treatment of patients with an increased level of sperm DNA fragmentation. The effectiveness of the most of them has not been confirmed in good quality studies. There is an urgent need for large randomized trials to determine the role of these methods in the treatment of male infertility associated with a high level of sperm DNA fragmentation.