Research Article Flow Cytometry Detection of Sperm DNA Fragmentation and Apoptotic Markers in the Semen of Infertile Males Huda Mossa Omran , 1,2 Moiz Bakhiet , 1 and Volker Ehemann 3 1 Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Center for Genetics and Inherited Diseases, Arabian Gulf University, Manama, Bahrain 2 Pulse Health Training Center, Manama, Bahrain 3 Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany Correspondence should be addressed to Huda Mossa Omran; hudamossa.omran@gmail.com Received 2 June 2021; Accepted 3 July 2021; Published 19 July 2021 Academic Editor: Julio Rosa e Silva Copyright © 2021 Huda Mossa Omran et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The effect of sperm molecular defects on fertilization and pregnancy outcome after assisted reproductive therapy (ART) is widely documented by both research and clinical societies. Sperm DNA fragmentation and abnormal chromatin condensation represent critical causes of male infertility. Advanced androgenic techniques for accurately identifying molecular defects help in selecting an appropriate treatment strategy. Additionally, specific markers of apoptosis are increasingly important in predicting male infertility. The ability of flow cytometry to estimate the quantity of sperm with DNA fragmentation or damage and multifactor measurements in immotile sperm have made this developed technique essential in fertility centers. The study is aimed at assessing the level of DNA fragmentation and apoptosis by measuring flow cytometry using new techniques. Flow cytometry analysis revealed a varying degree of DNA damage. It was able to quantify the degree of impairment even in samples with minimal DNA fragmentation. DNA damage was observed even in samples that were considered normal with a routine semen analysis. Flow cytometry was sensitive to changes in sperm apoptosis. Elevated p53 activity levels were associated with high DNA fragmentation. Meanwhile, B-cell lymphoma 2 (Bcl-2) activities showed a different pattern. In conclusion, flow cytometry for sperm DNA fragmentation and markers of apoptosis can be a valuable tool in assisted reproductive centers. 1. Introduction Exploring the impact of sperm DNA and apoptotic changes on male subfertility is being important along with the stan- dard semen analysis [1–3]. Zini et al. [4] reported that sperm DNA damage comprises a predictive factor for pregnancy loss after ART. The need for a precise approach to accurately measure this factor is increased. Several techniques in the andrology lab have been used to evaluate these markers [5]. The sperm chromatin dispersion (SCD) test is a method based on the shape of the characteristic halo that is created when sperm nuclear proteins are removed by acid denatur- ation [6, 7]. It is a direct method but with interlaboratory var- iability. The comet is another technique that qualitatively measures sperm DNA damage by visualising single- and double-strand breaks using electrophoresis [5]. A double- strand DNA appears at the head of a comet. The full head and tail emerge, while damaged double- and single-strand DNA fragments move towards the tail part. Therefore, this essay is an immensely useful tool to measure the DNA fragmentation index (DFI, %), which indicates the number of cells with DNA damage [8], and high DNA stainable (HDS) (%), which indicates the proportion of the histone-to-protamine transition in the immature sperm [9]. The disadvantages of this test are that the testing requires expensive equipment and a high concentration of sperm and that the reference range for the sample needs to be calibrated [5]. Hindawi International Journal of Reproductive Medicine Volume 2021, Article ID 9531775, 8 pages https://doi.org/10.1155/2021/9531775