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The Sperm DNA Integrity assay (SDIA) like the Sperm Chromatin Structure
Assay (SCSA) is a tool for measuring clinically important properties
of sperm nuclear chromatin integrity. Chromatin is that portion
of the cell nucleus which contains all of the DNA of the nucleus
in animal or plant cells.
The results correlate well with the potential of sperm from a
given male to produce embryos that would be sufficiently “competent
to produce a live birth. The SDIA utilizes the metachromatic features
of acridine orange (AO), a DNA probe, and the principles of flow
cytometry (FCM).
SDIA data are not well correlated with classical sperm quality
parameters and have been solidly shown to predict sub/infertility
and poor reproductive performance. The SDIA measures DNA damage.
The degree of abnormalities in the genetic material of the sperm
is expressed numerically as the DNA Fragmentation Index (DFI).
DNA damage may be present in sperm from both fertile and infertile
men. Therefore, this sperm DNA damage analysis may reveal a hidden
abnormality of sperm DNA in infertile men classified as unexplained
based on apparently normal standard sperm parameters.
Infertile men with abnormal sperm characteristics exhibit increased
levels of DNA damage in their sperm. Sperm from infertile men with
normal-appearing sperm may have DNA damage to a degree comparable
to that of infertile men with abnormal-appearing sperm. The data
suggests that an abnormal SDI assay is more likely to occur in
cases of abnormal semen parameters.
Cancer treatments are well known to adversely affect male fertility.
Reduction of sperm output arises from the cytotoxic effects of
chemo-or radiotherapy upon the spermatogenic epithelium.
Optimal sperm chromatin packaging seems necessary for full expression
of the male fertility potential. SDI assays emerge as predictors
of the probability to conceive and carry the pregnancy to viability.
The improvement seen in sperm motility after treatment is not
associated with a similar improvement in sperm DNA integrity (SDIA
assay results). These data suggest that sperm processing techniques
will not minimize sperm DNA damage and the potential transmission
of genetic mutations in assisted reproductive cycles.
It is important to add that most current data available on the
significance of abnormal SDIA results in infertile couples seeking
treatment has emanated from non-IVF pregnancies.
Preliminary data suggests the following :
• The viable (>12 weeks) IVF pregnancy rate (and thus
presumably also the birth rate) could be as much as 2 times lower
in women under 33yrs of age, whose husbands have abnormal SDI assays
( with a DFI of <30%). Results become progressively worse with
advancing maternal age such that at 35 yrs+, the viable pregnancy
rate could be as much as 3-4 times lower.
•
Although it is possible for abnormal SDIA results to sometimes
spontaneously revert back to normal, this probably occurs quite
infrequently.
•
Although abnormal SDIA results are detected in men with apparently
normal semen analyses, abnormal results are more commonly seen
in cases of men who have abnormal sperm parameters (abnormal sperm
count, motility and/or morphology)
• There is some suggestion that the use of antioxidant therapy
( Pycnogenol 200mg daily, L-Carnitine 3 grams per day, acetyl carnitine
500mg per day, Vitamin C 1,000mg per day, Vitamin E 800IU per day
and acupuncture and certain herbal medicines) taken for several
months, can causes the SDI assay to revert to normal in many cases.
There is some suggestion that men who have varicoceles ( a collection
of distended veins in the scrotum) associated with an abnormal
SDI assay may experience a reversion of the SDI assay back to normal,
3-6 months following surgical or radiological ablation of the varicocele.
Of course acupuncture and herbal medicine will enhance and stimulate
blood flow to the testicles facilitating a more rapid recovery
with greater possibility of healthy sperm production after a varicocelectomy.
In summary, an abnormal SDI assay augers poorly for the outcome
of fertility treatment in general and IVF/ICSI in specific. In
such cases, the fertilization rate and pregnancy rates are reduced
and the chance of early pregnancy loss appears to be increased
significantly. An abnormal SDIA result does not totally preclude
a successful pregnancy. The prognosis worsens progressively as
the age of the egg provider advances beyond 33yrs. Although abnormal
SDIA results rarely revert to normal spontaneously this can and
does happen on occasion.
Selective surgical ligation of a varicocele and medical anti-oxidant
treatment may be effective in restoring the SDIA to normal. Antioxidant
properties are to be found in Vitamins C and E and herbal medicine
specific to this situation.
It is quite likely that the SDIA or the SCSA will in time become
regarded as required baseline tests (to be performed, regardless
of their basic traditional semen analysis parameters (count,
motility and sperm morphology) in all cases of recurrent pregnancy
loss and IVF where the sperm provider has not previously participated
in a pregnancy that has proceeded beyond the 12th week (the traditional
point of likely viability).
It should be noted that when the typical sperm analysis reveals
normal count, morphology and motility this does not mean that sperm
DNA fragmentation is not manifest. In other words, unless the SDIA
test is specifically run, fragmentation issues will not be revealed.
This type of case then may be labeled ‘idiopathic’ infertility.
It is our opinion based on clinical experience that ideally, both
the man and the women should be treated even if there is no apparent
male factor evident. The reason for this is that stress has been
shown to reduce sperm count. Going through the tortuous trial of
trying to conceive leaves many couples extremely stressed out.
So, which at the time of sperm analysis everything appears normal,
over time, due to the stress inherent with the situation, the sperm
quantity may in fact be effected.
Therefore, including acupuncture, herbal medicine and the proper
supplements can be seen as either reactive (if pathology is evident)
or proactive (if pathology is not evident). It is our opinion that
proactive behavior often obviates the need to be reactive. Prevention
is key.
We are seeing impressive results in male factor cases.
Call the Berkley Center today and take control of your future:
212-399-3575
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