Discover the importance of sperm DNA fragmentation (SDF) testing, how it impacts ART outcomes, and ways naturopathic doctors can integrate this essential tool into fertility care.
By Dr. Rosia Parrish, ND
At the American Society for Reproductive Medicine 2024 (ASRM) conference in Denver, the session “From Double Helix to Double Trouble: Sperm DNA Fragmentation Unveiled” provided critical insights into sperm DNA fragmentation (SDF) and its growing importance in male fertility assessment. As naturopathic doctors, understanding the significance of SDF testing can elevate fertility care, improve patient outcomes, and create a more integrative approach to male factor infertility. This article discusses why SDF testing is essential, its effect on assisted reproductive technology (ART) outcomes, and why comprehensive male fertility evaluations are crucial for reproductive success.
Understanding Sperm DNA Fragmentation
Sperm DNA fragmentation (SDF) refers to breaks or damage within the DNA strands of sperm cells. Unlike a standard semen analysis that assesses parameters such as sperm count, motility, and morphology, SDF testing provides a deeper evaluation of sperm health by examining DNA integrity. High SDF has been associated with numerous reproductive challenges, including reduced fertilization rates, compromised embryo development, recurrent miscarriage, preterm birth, and complications such as preeclampsia.¹⁻⁴ High SDF also has long-term implications for offspring, including increased risks for cancer and neurodevelopmental disorders, including ADHD and autism.⁵
Understanding the Importance of SDF Testing
Since the placenta derives genetic material from both parents, paternal DNA quality influences maternal-fetal health. High SDF can contribute to abnormal placentation, raising risks for pregnancy complications.¹ ⁴ Given these associations, SDF testing is a crucial tool for male fertility evaluation, particularly in cases of recurrent pregnancy loss or ART failure.
When to Consider SDF Testing
There are specific clinical scenarios in which SDF testing should be prioritized, including:
- Recurrent Miscarriage: High SDF is a notable contributor to recurrent pregnancy loss. Identifying the DNA integrity of sperm can aid in uncovering the underlying causes of these losses and guide individualized treatment strategies.⁶
- Varicocele: This common cause of male infertility is linked to increased oxidative stress and elevated SDF. Studies show that varicocele repair can improve sperm DNA integrity, enhancing subsequent pregnancy outcomes.⁷ Addressing varicocele, whether surgically or through targeted therapies, can reduce SDF levels and bolster fertility success.
Assisted Reproductive Technology (ART) Planning: SDF testing is particularly important when considering ART such as IVF or ICSI. High SDF levels correlate with poorer ART outcomes, including reduced live birth rates and increased preterm birth and preeclampsia risks. Addressing SDF before starting ART can foster healthier pregnancies and reduce potential complications.¹ ⁴ ⁸
How SDF Impacts Pregnancy Outcomes
The ASRM keynote emphasized SDF testing’s clinical significance by linking it to pregnancy complications. For example, the risks of preeclampsia and preterm birth are higher when sperm DNA is compromised, as the placenta relies on both maternal and paternal genetic contributions.¹ ⁴ Furthermore, high SDF can impact embryo development and implantation, increasing miscarriage likelihood or ART failure.⁴
Beyond conception, high SDF can also affect the long-term health of offspring, raising the risk for neurodevelopmental issues and childhood cancers.⁵
Pregnancy Risks Associated with High SDF
By addressing SDF before conception, practitioners can help support not only pregnancy outcomes but also the future health of children.
Case Study: Managing SDF for Improved Fertility
James and Amelia, both in their early 30s, had been trying to conceive for over two years. Emily had experienced three miscarriages, each occurring in the first trimester. Conventional fertility tests showed no clear explanation for the recurrent losses. John’s semen analysis showed normal parameters, but further investigation with SDF testing revealed a high fragmentation index of 42%.
With these findings, John began a comprehensive treatment plan addressing oxidative stress and lifestyle factors. He reduced his exposure to environmental toxins, improved his diet, and took antioxidant supplements, including vitamins C and E, zinc, and CoQ10. Additionally, John underwent a successful varicocele repair after a physical exam confirmed the presence of a varicocele, which likely contributed to his high SDF.⁷
Six months after implementing these changes, John’s SDF levels dropped significantly, falling to 18%. Emily conceived naturally shortly afterward, and this time, the pregnancy progressed without complications. The couple welcomed a healthy baby boy, highlighting how SDF testing and targeted interventions can support healthier pregnancies and improved fertility outcomes.
Managing SDF for Improved Fertility Outcomes
Managing SDF effectively requires a comprehensive approach that includes:
- Lifestyle Interventions: Oxidative stress is a major contributor to DNA fragmentation. Risk factors include advanced paternal age, obesity, smoking, exposure to environmental toxins, and poor diet. Lifestyle changes, such as improving diet, quitting smoking, and minimizing toxin exposure, can significantly lower SDF.⁵
- Nutritional Support: Antioxidants, including vitamins C and E, zinc, and CoQ10, have shown potential in reducing oxidative damage to sperm DNA and improving SDF levels.¹ ⁵
- Varicocele Repair: Varicocele is a leading cause of high SDF. Surgical correction can enhance sperm DNA integrity and improve fertility outcomes, both in natural conception and ART.⁷
- Sperm Freezing Considerations: Before freezing sperm, it is crucial to assess SDF levels. Freezing sperm with high DNA fragmentation can further compromise genetic integrity, impacting future fertility success and offspring health.⁵
ART Limitations and the Need for a Holistic Approach
ART, particularly ICSI, provides options for couples dealing with male-factor infertility. However, ART does not eliminate the risks associated with high SDF. Techniques like selecting sperm using hyaluronic acid during ART can improve outcomes but do not replace the need for a comprehensive evaluation. Improving sperm DNA quality in the lab should not be the primary focus. Addressing the underlying causes of sperm damage is key.
SDF testing should be part of a thorough andrological evaluation, including medical history, physical examination, and hormone assessment. Only a holistic approach that addresses the root causes of high SDF, such as oxidative stress, varicocele, and lifestyle factors, can lead to lasting reproductive success.
Conclusion
The ASRM 2024 course underscores the importance of integrating SDF testing into male fertility evaluations. By addressing high SDF and its root causes, naturopathic doctors can support improved ART outcomes, healthier pregnancies, and enhanced long-term health for offspring. While SDF testing complements a comprehensive fertility evaluation, it does not replace it, underscoring the value of a holistic, integrative approach to male factor infertility.

Dr. Rosia Parrish, ND, is the founder and owner of Naturopathic Wellness Center of Boulder and a leading Holistic Fertility Specialist. As a Naturopathic Doctor and Functional Medicine Practitioner, she runs a telehealth-only clinic that specializes in naturopathic reproductive endocrinology and integrative fertility medicine. She holds a doctorate from Bastyr University, known for its excellence in naturopathic education, and has received advanced practitioner training through the Institute of Functional Medicine (IFM).
With a focus on complex fertility issues, Dr. Parrish excels at identifying the root causes of unexplained infertility, male factor infertility, recurrent pregnancy loss, and other reproductive health challenges. She thoroughly investigates underlying factors like inflammation, autoimmunity, hormonal imbalances, chronic infections, and environmental toxins, providing personalized treatment plans for both men and women. Her expertise extends to improving egg and sperm quality, regulating menstrual cycles, addressing PCOS, and enhancing overall reproductive health.
With over two decades of clinical and research experience, Dr. Parrish’s approach is rooted in compassionate, evidence-based care that supports optimal reproductive outcomes. Her work not only addresses immediate fertility goals but also prioritizes long-term health and wellness, making her a trusted ally in fertility preservation as well.
For more information or to schedule a free 15-minute discovery call, reach out to info.boulder@nawellness.com or visit www.nawellness-boulder.com
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