When couples face difficulty in getting pregnant, male fertility is often reduced to one number: the sperm count. But this is actually not entirely correct; sperm health is much more than simply assessing how many sperms are present. So, clinicians can tell the difference not simply based on how many sperm there are, but also based on the other parameters that have to be looked into during a standard semen analysis as per the WHO Semen Analysis laboratory guidelines.

Standard semen analysis mainly considers factors like sperm density/concentration, sperm motility, morphology, etc., when necessary, also including sperm viability, but does not include assessment of sperm DNA. It's important to understand that a low sperm count alone does not automatically mean that the sperm DNA is damaged. This is why, as a fertility specialist, I often explain to couples that in male fertility assessment, one needs to look beyond sperm count.

What Does Sperm Count Actually Tell Us?

Sperm count refers to the number of sperm in a semen sample. It is reported as sperm concentration, which is the number of sperm per ml as well as the total number of sperm in the entire ejaculate. A high sperm count is important for the process of conception as sperm have to travel through the female genital tract to reach and fertilise the egg. Nevertheless, only knowing how many sperm there are does not necessarily tell us if the sperm motility, shape or DNA structure is normal. This means that it might be possible for a male to have an acceptable sperm count but still may have bad motility or bad morphology. The WHO's current framework of reference on semen characteristics manual emphasises that semen analysis should not be viewed as a test to label a man fertile or infertile. semen analysis provides important information about male reproductive health.

Then What Is Sperm DNA?

Just like every cell in our body carries DNA, each sperm cell carries its own genetic blueprint, half of the genetic material that it will contribute to the embryo. Sperm DNA fragmentation involves damage or breaks in this genetic makeup.

Sperm DNA fragmentation is entirely different from sperm count in that while sperm count seeks to answer the question of how many sperm are present in the given semen sample, sperm DNA fragmentation refers to the breakage or damage in its genetic material. In simple terms, sperm count is more quantitative information, while sperm DNA fragmentation gives qualitative information about the integrity of the genetic material it carries.

It is possible for a sperm cell to appear healthy even under the microscope but still have damaged DNA.

There are a variety of issues that might lead to damage in the DNA of sperm; these include oxidative stress, infection or inflammation, varicocele, smoking, and others.

Can You Have A Normal Sperm Count But Damaged Sperm DNA?

Yes. This is one of the most important points for couples to understand. Routine semen analysis and sperm DNA fragmentation testing assess different aspects of sperm health. A normal semen analysis does not necessarily mean that every sperm has intact DNA.

At the same time, the reverse is also possible. A man with a low sperm count does not necessarily have severe DNA fragmentation. This is why male fertility should not be assessed by sperm count alone. The American Urological Association and American Society for Reproductive Medicine also emphasise that individual semen parameters are not highly predictive of fertility when considered in isolation.

Does Sperm DNA Fragmentation Affect Pregnancy?

There is evidence linking a high rate of DNA fragmentation with lower levels of reproductive outcomes, including pregnancy losses in certain conditions; however, it does not mean that "high fragmentation means infertility."

Each method has its own standards, and it remains controversial to give a clear clinical interpretation of results. For this reason, the new 2024 AUA/ASRM guideline on Sperm DNA Integrity Tests does not recommend performing it as a first-line test for all infertile men.

It might have a specific relevance in certain cases, especially in cases of recurrent pregnancy loss or repeated failed fertility treatment. Understanding the level of DNA integrity will help to gather extra data beyond a simple semen analysis.

When Should A Man Consider DNA Fragmentation Testing?

It should ideally be decided after consultation with a fertility specialist rather than ordered simply because a couple is anxious about fertility.

It may be considered when there is recurrent pregnancy loss, repeated IVF or ICSI failure, unexplained infertility in selected cases, or clinical circumstances suggesting a higher risk of sperm DNA damage. The important point is that DNA fragmentation testing should complement, not replace, a standard semen analysis and clinical evaluation.

What Can Men Do To Improve Sperm Health?

Improving sperm health takes time, as sperm production is a continuous process and takes around 10-12 weeks for the development of a new generation of sperm, so changing lifestyles cannot result in sudden enhancement. Simple lifestyle measures play a pivotal role in improving sperm health, like quitting tobacco, reducing consumption of alcohol, keeping weight under control, regular physical exercise, proper management of diseases, e.g., diabetes, prompt treatment of genital infections, and resolution of conditions like varicocele are all factors that may contribute to improvement of reproductive health.

And, it is not advisable to start antioxidants or fertility supplements on your own. A fertility expert should guide you about whether to take a supplement, since the benefits of supplements are not consistent. Supplementation should be based on individual assessment and medical condition.

The health of semen is determined using multiple parameters. Sperm count shows numbers, sperm motility reflects movement, morphology is about shapes, and DNA integrity informs us about the genetic material content of the sperm.

So, when male infertility is being assessed, instead of just asking, "What is the sperm count?" The question really should be, "What is the overall picture of my sperm health?"

That broader approach helps doctors identify potentially treatable male-factor issues and, importantly, prevents a single semen-analysis number from defining a man's fertility potential.

(By Dr Jyoti Tripathi, Fertility Specialist, Nova IVF Fertility, Indore)

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