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• W2121065380 abstract "The diagnostic semen analysis has been and remains the cornerstone laboratory test used for the evaluation of male factor infertility. Unfortunately, individual semen parameters do a poor job of separating fertile from infertile men. This is because the distributions of each parameter in fertile and infertile populations have a large degree of overlap.As a result of the limitations of the standard semen analysis, there have been many efforts to examine other aspects of sperm quality. Many assays have been developed; some never gained widespread use (zona-binding assays, in vitro cervical mucus penetration assays, evaluation of sperm capacitation), some became popular but because of expense and difficulty, are now rarely used (sperm penetration assays). In addition, many investigators have believed that the development of intracytoplasmic sperm injection (ICSI) has made the diagnosis of functional defects “irrelevant” as couples could be treated with ICSI without first diagnosing the specific functional sperm defect.The value of any diagnostic test rests on its ability to provide information that affects patient management. In the current medical economic climate, new diagnostic tests are given much more scrutiny than in years past. Tests that do not provide information on prognosis or that help direct patient care do little other than drive up the cost of medical care.The assessment of the degree of sperm DNA fragmentation has become common during the past several years. There are a variety of methods of measuring sperm DNA fragmentation, as well as a variety of different parameters that may be assessed. Currently, neither the American Society for Reproductive Medicine, nor the American Urological Association recommends the routine assessment of sperm DNA fragmentation as part of the standard male fertility evaluation.Despite this, there is much interest in this type of assay, as it measures a parameter different from the standard semen analysis parameters. Multiple meta-analyses have been performed on the utility of the assays in predicting clinical outcomes.Limited data on pregnancy by intercourse and after IUI indicate lower pregnancy rates with high levels of fragmentation. There is much more data evaluating pregnancy rates (PR) after IVF, which also seems to show a negative effect but not as dramatic as with intercourse or IUI. Pregnancy by ICSI alone seems much less affected, as are fertilization rates.More recent data indicate higher levels of miscarriage with high levels of sperm DNA fragmentation. Criticisms of the assays include the fact that the assay is done on samples other than the ones used for assisted reproductive technology (ART) and there is some inherent variability over time, although there remains controversy as to the degree of this variability. In addition, the assays measure the entire sperm population, and not all sperm have high levels of fragmentation. Finally, all of the assays involve treatments of the sperm (most commonly DNA-binding dyes), which make the individual sperm unusable for ART.The current report by Sánchez et al. (1Sánchez V. Redmann K. Wistuba J. Wübbeling F. Burger M. Oldenhof H. et al.Oxidative DNA damage in human sperm can be detected by Raman microspectroscopy.Fertil Steril. 2012; 98: 1124-1129Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar) on Raman microspectroscopy uses a unique and innovative approach to measure the fragmentation of individual sperm. This approach combines Raman spectroscopy and confocal microscopy to allow very precise focusing to the level of organelles and the detection of the chemical fingerprint of the sperm DNA. They demonstrated that this method correlates very well with other methods of measuring sperm DNA fragmentation, including flow cytometry.Although they utilized air-dried sperm, no dyes were used. This raises the possibility of applying this technique to live sperm. If this was successful, it could lead to an approach to choosing which sperm to use for ICSI based on a parameter other than appearance and motility. Although the data are preliminary, it is this type of innovative work that may lead to significant advances in the search for the perfect sperm. The diagnostic semen analysis has been and remains the cornerstone laboratory test used for the evaluation of male factor infertility. Unfortunately, individual semen parameters do a poor job of separating fertile from infertile men. This is because the distributions of each parameter in fertile and infertile populations have a large degree of overlap. As a result of the limitations of the standard semen analysis, there have been many efforts to examine other aspects of sperm quality. Many assays have been developed; some never gained widespread use (zona-binding assays, in vitro cervical mucus penetration assays, evaluation of sperm capacitation), some became popular but because of expense and difficulty, are now rarely used (sperm penetration assays). In addition, many investigators have believed that the development of intracytoplasmic sperm injection (ICSI) has made the diagnosis of functional defects “irrelevant” as couples could be treated with ICSI without first diagnosing the specific functional sperm defect. The value of any diagnostic test rests on its ability to provide information that affects patient management. In the current medical economic climate, new diagnostic tests are given much more scrutiny than in years past. Tests that do not provide information on prognosis or that help direct patient care do little other than drive up the cost of medical care. The assessment of the degree of sperm DNA fragmentation has become common during the past several years. There are a variety of methods of measuring sperm DNA fragmentation, as well as a variety of different parameters that may be assessed. Currently, neither the American Society for Reproductive Medicine, nor the American Urological Association recommends the routine assessment of sperm DNA fragmentation as part of the standard male fertility evaluation. Despite this, there is much interest in this type of assay, as it measures a parameter different from the standard semen analysis parameters. Multiple meta-analyses have been performed on the utility of the assays in predicting clinical outcomes. Limited data on pregnancy by intercourse and after IUI indicate lower pregnancy rates with high levels of fragmentation. There is much more data evaluating pregnancy rates (PR) after IVF, which also seems to show a negative effect but not as dramatic as with intercourse or IUI. Pregnancy by ICSI alone seems much less affected, as are fertilization rates. More recent data indicate higher levels of miscarriage with high levels of sperm DNA fragmentation. Criticisms of the assays include the fact that the assay is done on samples other than the ones used for assisted reproductive technology (ART) and there is some inherent variability over time, although there remains controversy as to the degree of this variability. In addition, the assays measure the entire sperm population, and not all sperm have high levels of fragmentation. Finally, all of the assays involve treatments of the sperm (most commonly DNA-binding dyes), which make the individual sperm unusable for ART. The current report by Sánchez et al. (1Sánchez V. Redmann K. Wistuba J. Wübbeling F. Burger M. Oldenhof H. et al.Oxidative DNA damage in human sperm can be detected by Raman microspectroscopy.Fertil Steril. 2012; 98: 1124-1129Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar) on Raman microspectroscopy uses a unique and innovative approach to measure the fragmentation of individual sperm. This approach combines Raman spectroscopy and confocal microscopy to allow very precise focusing to the level of organelles and the detection of the chemical fingerprint of the sperm DNA. They demonstrated that this method correlates very well with other methods of measuring sperm DNA fragmentation, including flow cytometry. Although they utilized air-dried sperm, no dyes were used. This raises the possibility of applying this technique to live sperm. If this was successful, it could lead to an approach to choosing which sperm to use for ICSI based on a parameter other than appearance and motility. Although the data are preliminary, it is this type of innovative work that may lead to significant advances in the search for the perfect sperm. Oxidative DNA damage in human sperm can be detected by Raman microspectroscopyFertility and SterilityVol. 98Issue 5PreviewTo determine whether Raman microspectroscopy can identify different levels of oxidative sperm nDNA damage and to corroborate the findings using an established method and an alternative but complementary spectroscopic technique. Full-Text PDF" @default.
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• W2121065380 date "2012-11-01" @default.
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• W2121065380 title "Refining the measurement of sperm DNA fragmentation" @default.
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• W2121065380 doi "https://doi.org/10.1016/j.fertnstert.2012.07.1140" @default.
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