DNA fragmentation test - information for patients

You have been asked to produce a sample of your semen for testing at the Andrology Laboratory at Cambridge IVF. A DNA fragmentation test may be a single test or as part of a series of tests being performed on you and your partner to assess your chances of achieving a pregnancy as a couple.

This test is recommended for all men over the age of 45 but is also suitable for couples who have been trying to conceive for one year or are considering IVF treatment. A DNA fragmentation test is also highly recommended for patients who are experiencing recurrent spontaneous miscarriages or unexplained (idiopathic) infertility.

Studies have shown that there is a high correlation in men who are infertile and damaged DNA in their sperm cells (DNA fragmentation), compared to men with healthy sperm. Patients who have a high percentage of sperm showing DNA fragmentation are more likely to experience fertility problems such as:

• Poor embryo development
• Failure for embryos to implant into the womb
• Increased miscarriage rate

The human sperm cell, in fact, is not just responsible for the expression of the father’s genes but also for activation and the development of the embryo during and after implantation.

The instructions for embryo development are encoded in the hereditary material found in the sperm head. This material is otherwise known as DNA. DNA consists of two strands made up of proteins and amino acids which pair together and coil up into the helical shape we all know. The DNA is packed even more tightly into structures known as chromosomes.

Genes are found on chromosomes, they code for all sorts of things in our bodies from the colour of our hair to the building instructions of enzymes that are responsible for embryo development.

There are many reasons why DNA in sperm cells can be damaged. The main reason is damage caused by free radicals which are not neutralised by antioxidants. Other associations include:

• Infections
• Drug use
• Cigarette smoking
• Obesity
• Environmental and occupational pollutants
• Fever
• Elevated testicular temperature
• Chronic diseases such as diabetes
• Poor diet

Most of the above can be improved to some extent by making positive lifestyle changes.

There are specific treatment options for couples where the patient’s sperm has a high DNA fragmentation index. Magnetic activated cell sorting (MACS) combined with ICSI, allows selection of DNA intact sperm that can then be injected directly into eggs. Any suitable quality embryos which develop in the laboratory can then be transferred directly into the womb 3-5 days later or frozen for future use.

In order to obtain the best possible semen sample you should observe the following:

1. Abstain from intercourse or masturbation for 2-5 days before producing the sample (unless you are advised otherwise by a member of the team at Cambridge IVF). Longer periods of abstinence are not usually recommended as this can negatively affect the quality of the sample.
2. Inform us of any illness or medication that you are taking
3. Samples for DNA fragmentation testing must be produced on site. We have provided comfortable, discrete and private rooms for your use when producing your sample. A video system has been installed which you may use.
4. For your own privacy please remember to lock the door when you are using the private room to produce a sample.
5. Contamination of the semen during production MUST be avoided. Wash and dry your penis and hands thoroughly before producing your sample into the container provided. Please use the soap and paper towels provided.
6. The sample must be produced by masturbation. Please do not use any lubricants as this may contaminate your sample. Collect the sample into the container provided to you pre-labelled with your name and date of birth.
7. Inform us if any of the sample is lost. Most of the sperm in the ejaculate are contained in the first portion. If you do miss some we may ask you to repeat the sample to ensure we obtain an accurate result
8. Ensure you fully complete the bottom part of your referral form including your duration of abstinence and whether you collected the entire sample.
9. Place your sample into the hatch in the sample production room and close the door. Press the switch to the side of the hatch and leave it turned on. This will inform a member of staff in the adjacent lab that your sample is ready to be collected for analysis.
10. Once you have produced your sample you are free to leave. Your results will be sent through to your referring doctor within ten working days (NHS patients) or to your email address (self-funded patients).

We realise this is a stressful time for you and we are asking you to carry out an intimate process in unnatural settings. If for any reason you cannot produce a sample please let us know, we will do everything we can to reassure you. If you have any questions or comments regarding the facilities or service please notify a member of staff either in the adjacent Andrology Laboratory or back in the reception area who will be very happy to help.

Thank you.