Sperm DNA Fragmentation (SDF)

What is SDF?

Sperm DNA Fragmentation (SDF) is an important additional piece of information about seminal quality. An SDF value that exceeds a threshold value of 30% suggests sub-par sperm quality (Evenson et al., 2002). The SDF value confers clinicians the power to make informed decisions in their daily practice and take action based on quantitative results.

What is the use of assessing SDF?

1. To distinguish which couples are suitable for treatment by IUI.  
2. To assess the quality of semen samples or donors for suitability.
3. To assess the efficacy of medical interventions or treatment of infectious diseases.
4. To provide answers to cases of unexplained infertility, ART failure or repeated abortions. 

MACS

What is MACS?

MACS is a method to select a non-apoptotic sperm. Apoptotic or apopotosis-like manifestation sperm have an externalized phosphatidylserine (EPS) on sperm surface, EPS is a marker of apoptotic or apoptosis-like manifestation sperm which have a DNA damage or sperm DNA fragmentation

DNA damage will lead sperm to have programmed cell death. There are many factors that have effect to sperm DNA such as environmental and life style factors, systemic diseases, or primary cause of male reproductive tract.

Who should to use macs?   

• TUNEL or SCSA assay show a DNA fragmentation (DFI)
• History of repeated or recurrent IVF/ICSI failure
• Abnormal sperm parameter or varicocele.

Clinical appraisal  

MACS has an advantage over a conventional sperm preparation (SW or DGC) in term of decreases DNSfrag sperm, which have MMP, CP-9 and EPS, more oocyte penetration potential sperm.  The advantage of MACS confirm by the recently publication, they found that sperm preparation by MACS + DGC will have more pregnancy rate around 1.5 times when compare with DGC alone

Surgical Sperm Retrieval

What is Surgical Sperm Retrieval?

Sperm extraction surgery is one of the treatments for infertility, which is a method of removing sperm from the testicles instead of removing it yourself. Surgery is used in cases where there is no sperm or a very small amount. After the sperm has been obtained, it will be mixed with the egg using the ICSI method immediately for approximately 10 percent of the men who come for treatment. If you have infertility, sperm cannot be detected. This has many causes, such as a blocked sperm duct. Does it cause the germs produced by the testicles to not reach the sperm exit? In the case where sperm production is low These can be performed surgically to find sperm. But except in cases where the testicles are unable to produce sperm at all. cannot use this method.

Types of sperm retrieval surgery :

How to use sperm search surgery? It depends on the cause of the lack of sperm. Some methods may be better than others. It depends on the case of the absence of sperm. Most of the sperm obtained through surgery is not mature sperm and needs to be fertilized with an egg using the ICSI method.

• Percutaneous Sperm Aspiration (PESA) 
  It is often the first method used in sperm retrieval surgery. This method is short and painless. without surgical scars A needle will be inserted through the scrotum into the semen duct. The semen will be sucked. They are taken out and analyzed to determine the number and movement of sperm. This method generally takes 10-20 minutes and uses only local anesthesia or sleeping pills.
• Micro-epididymal Sperm Aspiration (MESA)
  It is a method that requires anesthesia. The patient will undergo surgery on the scrotum, making a small incision into the semen collecting duct. The semen is then examined for the number and movement of sperm under a microscope.
• Testicular Sperm Aspiration (TESA)
  If no sperm can be detected from the semen duct. A needle may be inserted directly into the testicle. Some pieces of tissue will be taken out to be used for sperm testing.
• Testicular Sperm Extraction (TESE)This surgery involves small incisions in the scrotum and testicles. Also known as a testicular biopsy. Surgery requires anesthesia as it can be painful. However, symptoms will improve within 3 days after surgery.

Types of sperm retrieval surgery

Sperm retrieval surgery is relatively risk-free. What risks may be encountered? is bleeding and infection in the surgical wound area But it is found in only 3 percent of patients. Including the risks that may arise from anesthesia.

Success from sperm search surgery

Success depends on the type of sperm retrieval surgery and how much sperm the man has. This is because the sperm that is obtained may not yet be fully grown. and cannot be fertilized with eggs by the general in vitro fertilization (IVF) method, but must be fertilized by the ICSI method.