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Question 56. What is the Sperm Chromatin Structure Assay (SCSA), and should my husband have it done?

Posted Oct 15 2011 11:01am
The Holy Grail of Reproductive Endocrinology is the test that definitively tells us whether a patient has a good egg or a good sperm. This is not to be confused with the Holy Grail of Monty Python which is one of the finest films ever made and won the Oscar for "Best Movie Ever" the year after Highlander won that very same award. If you don't get these jokes then don't worry as it probably demonstrates that you are a lot more normal than me and explains why I spent every Saturday night in high school watching the Love Boat....

Back to fertility. So the million dollar question remains is there a good egg and a good sperm that can make a baby? The answer is we don't know until you actually deliver a healthy baby and then the answer is "yes" (obviously).

There have been tests proposed to answer this question. But do not be misguided into thinking that a woman's FSH, estradiol, AMH and antral follicle count answer that question...they do NOT.

Similarly, tests on sperm have been proposed to answer this question for men. I don't think that we have an answer but the SCSA has been proposed as a predictive test. Personally, I have not used this test as my understanding is that there is no level of sperm DNA fragmentation that precludes pregnancy. So let's go to the book and see what Dr D and yours truly had to offer on this subject.

56. What is the Sperm Chromatin Structure Assay (SCSA), and should my husband have it done?

The Sperm Chromatin Structure Assay (SCSA) has been proposed as a means to predict the likelihood of pregnancy in cases of male factor infertility. This test analyzes the degree of DNA fragmentation present in a representative sample of sperm. Increased levels of DNA fragmentation seem to be associated with reduced pregnancy rates, including poorer treatment outcomes with IVF and ICSI. There is no level of fragmentation above which pregnancy is completely ruled out, however, so the SCSA cannot ultimately provide a means to absolutely recommend the use of donor sperm over the sperm from the male partner. If a couple is making a choice between the use of donor sperm compared with partner sperm, then the SCSA may provide a relative indication to use the donor sperm option. At this time, most experts consider this test to be experimental.
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