Infertility tests which raise more questions than they answer

Both doctors and patients are fascinated by new and fancy diagnostic tests . When things don't go as predicted during the IVF cycle, the natural response is to run more tests , so that we can get more information , which will allow us to pinpoint the problem and make a more accurate diagnoses.

For example, when your patient has poor quality embryos and you suspect this is because of a sperm problem, the first question the patient is going to ask is, " How do prove that this is because of a sperm defect?"

One of the tests available to test for sperm function is the sperm DNA fragmentation test, and it's very tempting to order this. After all, the sperm is just a DNA carrier -
a packaged missile which delivers the man's DNA into the egg to create a new embryo. If there is a lot of sperm DNA fragmentation , then isn't it obvious that you will get poor quality embryos with lots of fragmentation ? After all, if  the sperm quality is impaired , and if the sperm provides 50% of the DNA to the embryo, and if this DNA is fragmented, then it's logical to conclude that this is a cause and effect relationship - that poor quality embryos in a man with defective sperm are because of the poor quality of the sperm.

I wish life were that simple , but biology is far more complicated, and does not always follow what seems to be logic and common sense.  While it is true that men with high sperm DNA fragmentation are more likely to have fertility issues, it's also equally true that for the individual patient there is no cut-off value for sperm DNA fragmentation which demarcates fertile men from infertile men.  This means that there are
lots of fertile men who have high DNA sperm fragmentation levels; and that there will be men whose sperm DNA fragmentation is completely normal , who will still end up with creating abnormal fragmented embryos in the lab, even when they do ICSI with high quality donor eggs.

This is why we need to be selective when ordering these tests. Ordering them is easy, but interpreting the test for the individual patient is very difficult ! How do you make intelligent use of the information once you get the test result - that's what makes medicine so challenging and complex !

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