What steps can men take to optimise fertility before starting IVF treatment?
Pre-IVF optimisation of male fertility should be guided by the underlying cause of infertility, which may involve a male factor, a female factor, or a combination of both. In cases where IVF is being undertaken due to recurrent miscarriage, further investigation of the male partner is often clinically relevant, as increased sperm DNA fragmentation has been associated with a higher risk of recurrent pregnancy loss.
A normal semen analysis does not always exclude underlying sperm dysfunction. Conventional semen parameters—such as concentration, motility, and morphology—do not assess DNA integrity. As a result, sperm DNA fragmentation may be present even when routine results are within normal reference ranges. Elevated DNA fragmentation has been associated in some studies with impaired embryo development, reduced blastocyst formation, and increased risk of early developmental arrest.
For this reason, in selected cases, advanced diagnostic testing may be considered prior to IVF treatment to provide a more comprehensive assessment of sperm function. Where abnormalities such as elevated DNA fragmentation are identified, laboratory techniques including advanced sperm selection methods (e.g. microfluidic sperm sorting) may be used in assisted conception procedures such as IVF and ICSI to help isolate sperm with improved functional quality.
Alongside medical evaluation, general lifestyle factors may also influence sperm quality. Evidence suggests that optimising body weight, reducing alcohol consumption, avoiding smoking, improving diet quality, and minimising exposure to excessive heat or environmental toxins may support overall sperm health over time.
Overall, a structured and individualised approach is recommended, combining standard semen analysis with targeted advanced testing where appropriate, to ensure that male fertility factors are fully assessed prior to IVF treatment.
How long should men wait before repeating fertility tests after treatment or lifestyle changes?
When evaluating changes in male fertility, timing is important. Spermatogenesis, the process by which sperm are produced and mature, takes approximately 74 days, with an additional period required for transport through the epididymis before ejaculation. As a result, meaningful changes in sperm quality are typically not reflected in semen analysis results for around three months following lifestyle modifications, medical treatment, or surgical intervention. Therefore, repeat testing is often recommended after approximately 3 months to allow sufficient time for a new population of sperm to develop.
For men with elevated sperm DNA fragmentation, the underlying cause can influence both treatment options and the expected timeframe for improvement. Increased single strand DNA fragmentation is commonly associated with oxidative stress, infection, inflammation, varicocele, smoking, obesity, and other lifestyle or environmental factors. When these contributing factors are identified and addressed, improvements in DNA integrity may be observed following a complete spermatogenic cycle, making reassessment after approximately three months clinically appropriate.
In cases where infection or inflammation is identified, microbiome testing and targeted treatment may be recommended by the treating clinician. Follow-up microbiome testing can help determine whether the condition has resolved and whether sperm quality has improved. If symptoms or laboratory markers persist, further investigation may be required to assess for ongoing infection, inflammation, or other contributing factors.
It is important to recognise that not all forms of sperm DNA damage are equally influenced by lifestyle interventions. While oxidative stress is a major contributor to single strand DNA fragmentation, double strand DNA damage may be associated with underlying testicular dysfunction, impaired chromatin packaging, ageing, or genetic factors. In these situations, lifestyle changes alone may have a more limited effect, and additional treatment strategies may need to be considered. Such treatments include advanced sperm selection techniques which may be considered where elevated double strand DNA fragmentation is identified. Microfluidic sperm sorting technologies, such as Zymōt®, have been developed to select highly motile sperm with lower levels of DNA damage for use in assisted reproductive treatments. While these technologies do not directly treat the underlying cause of DNA fragmentation, they may help optimise sperm selection during fertility treatment in appropriately selected patients.
When a clinically significant varicocele is diagnosed and surgical repair (varicocelectomy) is performed, semen parameters are not expected to improve immediately. Following surgery, the testes require time to recover and complete a new cycle of spermatogenesis. Depending on the clinician, they may recommend repeat semen analysis at this stage to assess treatment response.
Ultimately, decisions regarding repeat testing and further management should be individualised, taking into account the patient's fertility history, test results, underlying diagnosis, and reproductive goals.
Can improving sperm health before IVF increase the chances of successful embryo development?
Yes, as mentioned previously when lifestyle factors are changed in a positive way towards a healthier lifestyle, they can affect sperm in a pssitive way and aid them in their chances to lead to a pregnancy.
In addition, further measures such as the use of microfluidics can help reduce dna fragentation in sperm therefore selecting sperm of a higher dna quality for ivf treatment, therefore reducing the chances of early embryo arrested development and miscarriages.
As well as previously mentioned, varicocele surgery can also lead to better sperm health.
When should sperm DNA fragmentation testing be considered?
Sperm DNA fragmentation (SDF) testing should be considered in selected clinical situations rather than being used routinely for all infertile men. According to Esteves et al. (2021), recent clinical practice guidelines (CPGs), particularly the 2017 Society for Translational Medicine (STM) guideline, recommend SDF testing for couples with unexplained infertility, where standard semen analysis fails to identify a cause of infertility (Agarwal et al., 2017). The guidelines also recommend testing in cases of recurrent pregnancy loss (RPL), as increased levels of sperm DNA fragmentation have been associated with a higher risk of miscarriage (Agarwal et al., 2017). In addition, SDF testing may be beneficial for men with known risk factors for sperm DNA damage, such as unhealthy lifestyle habits, exposure to environmental or occupational toxicants, advanced age, varicocele, or genital tract infections (Agarwal et al., 2017).
The STM guideline further recommends considering SDF testing for couples who have experienced repeated unexplained failures of assisted reproductive treatments, including intrauterine insemination (IUI), in vitro fertilisation (IVF), or intracytoplasmic sperm injection (ICSI), as SDF testing may help identify an underlying male factor that is not detected through conventional semen analysis (Agarwal et al., 2017, as cited in Esteves et al., 2021). This information may assist clinicians in selecting more appropriate treatment strategies for affected couples (Esteves et al., 2021).
However, Esteves et al. (2021) emphasise that these recommendations should be interpreted with caution. Although the 2017 STM guideline was the first to systematically synthesise the available evidence and provide clinical guidance for the use of SDF testing, subsequent expert reviews concluded that many of its recommendations were based on low-quality evidence, highlighting the need for further high-quality research before SDF testing can be recommended more widely in routine clinical practice (Esteves, Agarwal, Cho, et al., 2017; Majzoub et al., 2017, as cited in Esteves et al., 2021). Therefore, while SDF testing can provide valuable additional information in specific clinical scenarios, its use should be guided by individual patient circumstances and interpreted alongside other clinical findings (Esteves et al., 2021).
References:
Esteves SC, Zini A, Coward RM, Evenson DP, Gosálvez J, Lewis SEM, Sharma R, Humaidan P. Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations. Andrologia. 2021 Mar;53(2):e13874. doi: 10.1111/and.13874. Epub 2020 Oct 27. PMID: 33108829; PMCID: PMC7988559.
Agarwal, A. , Cho, C. L. , Majzoub, A. , & Esteves, S. C. (2017). The Society for Translational Medicine: Clinical practice guidelines for sperm DNA fragmentation testing in male infertility. Translational Andrology and Urology, 6(Suppl. 4), 720–733. 10.21037/tau.2017.08.06 [DOI] [PMC free article] [PubMed]
