The Test That Changed Everything: DNA Fragmentation

If we could pick one lesson from our entire IVF journey, it would be this: get a sperm DNA fragmentation test. From the start. Before the first cycle.

What happened in the first two cycles

In our first IVF cycle, everything seemed to go perfectly. 11 oocytes were retrieved. All 11 fertilized. Day one looked flawless.

By day five, none were left.

Zero. Out of eleven.

It was devastating. But we believed what the doctor told us: “It happens sometimes.” We believed it was bad luck. That next time would be different.

The second procedure, same clinic, went identically. The same promising initial results. The same collapse by day five. The same response from the doctor: no investigation, no protocol change, nothing.

As if the first failure had never happened.

The cause nobody looked for

It was only at the second clinic, where we consulted an andrologist, that a more complete set of tests was ordered. Among them: the DNA fragmentation test.

Sperm DNA fragmentation measures how damaged the genetic material inside the sperm is. High fragmentation means that while sperm can fertilize eggs, the resulting embryos have a very high probability of not developing properly.

My result: around 30% fragmentation. At this level, it was nearly impossible for our embryos to survive to day five - exactly what we’d already observed twice.

The solution that changed everything

The treatment? A supplement called Impryl (an active folic acid, methylfolate, specifically designed for sperm quality) and some lifestyle adjustments.

After a few months of treatment, fragmentation dropped to approximately 4%.

That’s it. That’s how simple it was. One pill that nobody at the first clinic thought was necessary. One test that nobody ordered. One cause that nobody investigated.

Two cycles, months of hormonal treatment for my wife, thousands of euros, emotional devastation - all of it could have been avoided.

Why isn’t this test standard?

It’s a question we still don’t have a satisfying answer to. The DNA fragmentation test isn’t expensive. It’s not invasive. It doesn’t take long. And it can identify a common cause of IVF failure.

Yet many clinics don’t include it in their standard panel. Maybe out of habit. Maybe out of ignorance. Maybe because it’s simpler to jump straight to the procedure than to investigate thoroughly.

What we learned is simple: don’t rely on the clinic to order all the necessary tests. Research it yourself. Ask specifically. Insist.

What you should know about DNA fragmentation

Levels: under 15% is considered normal; 15-25% is moderate; over 25% is high and can significantly impact IVF
Causes: oxidative stress, varicocele, infections, lifestyle (smoking, alcohol, sedentary habits), age, toxin exposure
Treatment: specific antioxidants (like Impryl), lifestyle changes, sometimes surgery for varicocele
Timing: the test should be done before the first cycle, not after two failures

Our direct advice

If you’re starting IVF and the doctor doesn’t mention DNA fragmentation, ask about it. If they minimize its importance, request it anyway. If they refuse, find an andrologist who does it.

It’s a simple test. Its result can completely change the treatment strategy. It can save cycles, money, and - most importantly - suffering.

We found out too late. We hope you find out in time.

References

Agarwal A, Majzoub A, Baskaran S, et al. “Sperm DNA Fragmentation: A New Guideline for Clinicians.” World Journal of Men’s Health, 2020;38(4):412-471.
Evenson DP. “Sperm Chromatin Structure Assay (SCSA) for Fertility Assessment.” Current Protocols, 2022;2(8):e508.
Ribas-Maynou J, et al. “Clinical implications of sperm DNA damage in IVF and ICSI: updated systematic review and meta-analysis.” Biological Reviews, 2021;96(4):1284-1300.
de Ligny W, et al. “Antioxidants for male subfertility.” Cochrane Database of Systematic Reviews, 2022;Issue 5.

Note: The DNA fragmentation thresholds cited above (under 15% normal, 15-25% moderate, over 25% high) are based on the SCSA assay. Other assays may use different cutoffs. Our personal experience with Impryl was significant, though clinical evidence on antioxidant supplementation for DNA fragmentation shows mixed results. Always consult your andrologist for personalized guidance.

This is the fourth in a series of articles about our IVF journey. We’re sharing what we learned across 6 cycles, three clinics, and five years - not as medical advice, but as the honest account we wish we’d had when we started.

Dan