Sperm carry half the genetic blueprint of a future embryo. When that DNA is damaged — through breaks in the strands, oxidative stress, or faulty sperm production — the resulting sperm may still appear normal under a microscope and have normal motility, but carry genetic material that is compromised.

The DNA Fragmentation Index (DFI) measures the percentage of sperm with damaged DNA in a given sample. A high DFI is associated with lower fertilization rates, poorer embryo development, higher rates of early miscarriage, and reduced IVF success — even in cycles that appear to be progressing normally up to the point of transfer.

DNA fragmentation testing is not part of the routine workup for every couple, but is specifically indicated in:

• Unexplained infertility — normal semen analysis but no pregnancy after adequate attempts
• Recurrent miscarriage (two or more pregnancy losses)
• Repeated IVF/ICSI failures despite good-quality embryos
• Advanced paternal age (over 45)
• Significant exposure to tobacco, alcohol, heat, radiation, or environmental toxins
• Presence of varicocele (varicose veins in the scrotum, which raise testicular temperature)
• History of chemotherapy or radiation

The decision to include this test in your workup is made on a case-by-case basis during your consultation with Dr. Glujovsky.

Transferring multiple embryos increases the risk of twins and triplets — which are not a success, they are a complication. Twin pregnancies carry higher rates of premature birth, low birth weight, and maternal complications.

Dr. Glujovsky follows an elective single embryo transfer (eSET) policy in most cases, consistent with major international guidelines including those from ASRM and ESHRE. The goal is one healthy baby, not the fastest path to a positive test.

Elevated DNA fragmentation is not a dead end. Depending on the degree of fragmentation and its suspected cause, several strategies can help:

• Lifestyle modification — stopping smoking, reducing alcohol, avoiding heat exposure (laptops on lap, hot baths, saunas), and antioxidant supplementation can reduce oxidative damage over 2–3 sperm production cycles (~74 days each).
• Surgical sperm retrieval — testicular sperm (obtained by TESE or TESA) typically has significantly lower DNA fragmentation than ejaculated sperm, because testicular sperm have not been exposed to the same oxidative environment. This is a meaningful option for men with very high DFI.
• ICSI with careful selection — using high-magnification selection techniques to choose the most morphologically intact sperm for injection.
• Treating the underlying cause — varicocele repair has been shown to reduce DFI in some studies. Other medical conditions are addressed as appropriate.

The appropriate strategy depends on your specific DFI result, the suspected cause, and the overall clinical picture. Dr. Glujovsky reviews all of these options in the context of your complete case.

The relationship between DNA fragmentation and outcomes is real but complex. High DFI consistently predicts lower success rates, but the threshold that is “too high” for a given couple depends on multiple factors including female age, ovarian reserve, and the number of embryos available.

It is also important to note that DNA repair mechanisms in the oocyte can partially correct sperm DNA damage — particularly in younger women with high-quality eggs. This means that the same DFI result may have different clinical implications depending on the female partner’s profile.

Dr. Glujovsky interprets fragmentation results within the full context of your case — not as an isolated number — and recommends interventions only when the evidence supports a meaningful clinical benefit.