A Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis on the clinical utility of sperm DNA fragmentation testing in specific male infertility scenarios

Infertility affects approximately 15% of couples globally, with male infertility directly or indirectly responsible for about 60% of the cases (1,2). Conditions compromising male fertility potential include varicocele, congenital and genetic abnormalities, endocrine disorders, genitourinary infection, systemic diseases, and exposure to gonadotoxins, which can be identified through a comprehensive male infertility workup (3). A medical history, physical examination, and semen analysis are the minimum standards for the evaluation of men seeking fertility (3). Among these, routine semen analysis is the central laboratory test in male infertility evaluation (4). However, assessment of semen volume, sperm count, sperm motility, and sperm morphology rarely provides robust discriminatory information of the male fertility potential, unless at extremely low levels (5,6). As a result, half of the male infertility cases are deemed as unexplained or idiopathic due to currently existing limitations in diagnostic modalities (7,8)