ASRM adds a sperm DNA test to its 2026 miscarriage guideline, with limits on when it gets used

Earlier this year, the American Society for Reproductive Medicine released the first revision of its recurrent pregnancy loss guidance since 2012, and it added a recommendation that the prior version did not carry. In defined cases, clinicians should test for sperm DNA fragmentation, a measure of how much genetic material inside the sperm is broken or damaged.

Semen analysis, the standard first test for male fertility, counts sperm and checks whether they swim. It does not look at the DNA inside them. That gap is what the 2026 update targets.

Sperm DNA fragmentation is what it sounds like. Strands of DNA in the sperm head are nicked, missing, or improperly packaged. A sperm with fragmented DNA can still reach and fertilize an egg, but the resulting embryo can struggle to develop. Research has linked the marker to miscarriage and to lower live birth rates after IVF. Tests for it have existed for decades but were not part of the standard workup.

The 2026 committee opinion is conditional, not a universal screen. It places sperm DNA fragmentation testing after two other steps come back empty: genetic evaluation of miscarriage tissue, and imaging or procedures to rule out uterine structural problems. Only when those standard workups fail to identify a cause does the guideline suggest adding the sperm DNA test. The order is the point. It is a targeted next step, not a replacement for the existing pathway.

Sarah Elizabeth Richards, a freelance science journalist who wrote the underlying feature for Scientific American, frames the update as a shift in what "unexplained" recurrent pregnancy loss can mean. Couples handed that label under the prior workup now have a defined next test to ask about, and a defined reason to ask: the previous baseline left a known, testable contributor unmeasured.

Reducing alcohol, improving diet and exercise, and targeted supplements have been reported as effective in some patients. The source language is "in some cases," and the underlying evidence is mixed across studies. The 2026 guideline is not a treatment recommendation; it is a diagnostic one. The lifestyle levers are described as ways to lower a marker, not as a guaranteed route to a live birth.

Genetic evaluation of prior miscarriage tissue and a uterine structural workup need to come back empty before the sperm DNA fragmentation test enters the conversation. Under the 2026 committee opinion, that sequencing is now guideline-backed in a way it was not under the 2012 version.