What is follicular unit extraction? Follicular unit extraction is process by which small groups of follicles (between 1 and 4 hair follicles in a graft) are transplanted into receptor site. This allows for equal distribution of grafts resulting in a more natural-looking appearance.

What is procedure like? Follicular unit extraction is performed with a punch-like scalpel that cuts skin around follicular unit and facilitates removal of follicle from donor area. About 1 to 3 follicles are removed at a time.

The results correlate well with potential of sperm from a given male to produce embryos that would be sufficiently “competent to produce a live birth. The SDIA utilizes metachromatic features of acridine orange (AO), a DNA probe, and principles of flow cytometry (FCM).

SDIA data are not well correlated with classical sperm quality parameters and have been solidly shown to predict sub/infertility and poor reproductive performance. The SDIA measures DNA damage. The degree of abnormalities in genetic material of sperm is expressed numerically as DNA Fragmentation Index (DFI). DNA damage may be present in sperm from both fertile and infertile men. Therefore, this sperm DNA damage analysis may reveal a hidden abnormality of sperm DNA in infertile men classified as unexplained based on apparently normal standard sperm parameters.

Infertile men with abnormal sperm characteristics exhibit increased levels of DNA damage in their sperm. Sperm from infertile men with normal-appearing sperm may have DNA damage to a degree comparable to that of infertile men with abnormal-appearing sperm. The data suggests that an abnormal SDI assay is more likely to occur in cases of abnormal semen parameters.

Cancer treatments are well known to adversely affect male fertility. Reduction of sperm output arises from cytotoxic effects of chemo-or radiotherapy upon spermatogenic epithelium.

Optimal sperm chromatin packaging seems necessary for full expression of male fertility potential. SDI assays emerge as predictors of probability to conceive and carry pregnancy to viability.

The improvement seen in sperm motility after treatment is not associated with a similar improvement in sperm DNA integrity (SDIA assay results). These data suggest that sperm processing techniques will not minimize sperm DNA damage and potential transmission of genetic mutations in assisted reproductive cycles.

It is important to add that most current data available on significance of abnormal SDIA results in infertile couples seeking treatment has emanated from non-IVF pregnancies. Preliminary data suggests gollowing:

• The viable (>12 weeks) IVF pregnancy rate (and thus presumably also birth rate) could be as much as 2 times lower in women under 33yrs of age, whose husbands have abnormal SDI assays ( with a DFI of <30%). Results become progressively worse with advancing maternal age such that at 35 yrs+, viable pregnancy rate could be as much as 3-4 times lower.

• Although it is possible for abnormal SDIA results to sometimes spontaneously revert back to normal, this probably occurs quite infrequently.