Recent studies reveal that the causes of miscarriages are not exclusively linked to women. One of the leading explanations for recurrent miscarriages points to high levels of DNA fragmentation in sperm cells. Why does this happen, and what are the most effective treatments that can help reduce this phenomenon?
A Paradigm Shift: Men Also Play a Role in Recurrent Miscarriages
For years, studies on recurrent miscarriages focused mainly on factors related to women, examining anatomical, genetic, hormonal, immunological, and environmental aspects. Despite these efforts, over half of recurrent miscarriage cases remained unexplained.
In recent years, a significant shift has been occurring in research. The scientific community is increasingly recognizing the male factor’s contribution to recurrent miscarriages. Studies show a strong correlation between high levels of DNA fragmentation in sperm cells and pregnancy loss.
Could we finally be getting closer to solving some of the so-called “unexplained” cases?
How Does This Happen?
DNA fragmentation in sperm has a complex effect. While, in some cases, the egg is capable of repairing minor DNA damage, if the level of DNA fragmentation is too high, the egg fails to repair the damage, leading to pregnancy complications, implantation failure, or miscarriage.
Researchers found that the higher the DNA fragmentation rate in sperm, the greater the risk of pregnancy loss. Even if fertilization occurs, the damage in the sperm’s genetic material can lead to developmental defects in the embryo, pregnancy termination, or halted fetal development.
The Male Factor: An Integral Part of the Diagnostic Process
A key insight from these findings is that recurrent miscarriage investigations should not focus solely on women. Traditionally, many men believed that their responsibility ended with fertilization, assuming the burden of maintaining the pregnancy rested entirely on the woman.
Today, it is understood that men must also undergo diagnostic evaluations, especially when no clear female-related cause for the recurrent miscarriages has been found.
Doctors now recommend advanced sperm tests that can detect DNA fragmentation, such as TUNEL and SCSA, which provide a more precise and detailed analysis of sperm quality compared to standard semen tests.
What Causes DNA Fragmentation in Sperm?
The sperm’s DNA is highly compact and protected during development, but various factors can compromise its integrity. These include:
- Oxidative stress (Seminal Oxidative Stress) – Excessive oxidative damage can lead to DNA fragmentation. Studies have found that men who experienced recurrent miscarriages had significantly higher oxidative stress levels compared to control groups.
- Genetic or epigenetic changes – These can impact the sperm’s ability to carry stable genetic material.
- Varicocele (enlarged testicular veins) – This condition increases testicular temperature and reduces oxygen supply, leading to increased oxidative stress, which damages sperm DNA.
- Lifestyle factors – Poor diet, smoking, excessive alcohol consumption, and metabolic conditions like diabetes and obesity are linked to higher levels of DNA fragmentation.
How Can DNA Fragmentation in Sperm Be Treated?
There are several strategies to reduce DNA fragmentation and improve sperm quality:
- Lifestyle Changes –
- Adopting a healthy diet rich in vegetables, fish, and whole grains (such as the Mediterranean diet).
- Reducing smoking and alcohol consumption.
- Engaging in regular exercise, which has been shown to reduce sperm DNA damage.
- Varicocele Treatment –
- Surgical correction of varicocele has been found to significantly reduce sperm DNA fragmentation levels, particularly in men experiencing recurrent miscarriages.
- Antioxidant Supplements –
- Studies indicate that antioxidants may help reduce DNA fragmentation, but the optimal dosage and treatment duration remain unclear.
- Hormonal Treatment –
- Some research suggests that medications like Letrozole (an aromatase inhibitor) and FSH (Follicle Stimulating Hormone) can reduce DNA fragmentation and improve pregnancy outcomes.
- Using Testicular Sperm Instead of Ejaculated Sperm –
- Studies have found that sperm extracted directly from the testes has significantly lower DNA fragmentation levels than ejaculated sperm. Using testicular sperm in assisted reproductive treatments (IVF/ICSI) has been linked to higher pregnancy and birth success rates.
- Advanced Sperm Selection Methods –
- Technologies like MACS (Magnetic Activated Cell Sorting) and PICSI (Physiological ICSI) can help select higher-quality sperm with lower DNA fragmentation, increasing the chances of a successful pregnancy.
Conclusion
The understanding of male fertility’s role in recurrent miscarriages has changed dramatically in recent years.
Recurrent pregnancy loss is not always due to female factors alone, and men must also be evaluated and treated when necessary.
Through advanced sperm testing, lifestyle adjustments, medical treatments, and improved sperm selection techniques, it is possible to reduce DNA fragmentation and improve pregnancy success rates.
For couples experiencing recurrent miscarriages, these findings offer new hope and potential solutions that were previously overlooked.
Article Contributors:
- Dr. Shlomi Barak – CEB Medical Director
