Sperm DNA fragmentation is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in reproductive cycles of non–male factor infertility

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Edson Borges Jr., M.D., Ph.D., Bianca Ferrarini Zanetti, Ph.D., Amanda Souza Setti, M.Sc., Daniela Paes de Almeida Ferreira Braga, Ph.D., Rodrigo Rosa Provenza, B.Sc., Assumpto Iaconelli Jr., M.D.



To study the implications of sperm DNA fragmentation (SDF) in intracytoplasmic sperm injection cycles for non–male factor infertility.


Prospective cohort study.


Private university-affiliated IVF center.


Data from 475 cycles performed from June 2016 to June 2017.


Cycles were divided according to SDF rate into two groups: <30% SDF (n = 433) and ≥30% SDF (n = 42). Laboratory and clinical outcomes were compared between groups by generalized linear models adjusted for potential confounders.

Main Outcome Measure(s)

Embryo quality and miscarriage rates.


Fertilization rate was similar between groups (≥30% SDF, 85.28% ± 1.06% vs. <30% SDF, 90.68% ± 3.61%). Significantly lower rates of normal cleavage speed (≥30% SDF, 61.12% ± 4.21% vs. <30% SDF, 72.53% ± 1.24%), high-quality embryos at day 3 (≥30% SDF, 23.07% ± 5.56% vs. <30% SDF, 36.41% ± 1.53%), blastocyst formation (≥30% SDF, 39.09% ± 2.73% vs. <30% SDF, 58.83% ± 7.59%), blastocyst quality (≥30% SDF, 11.97% ± 1.22% vs. <30% SDF, 30.09% ± 2.39%), and implantation (33.24% ± 1.66% vs. <30% SDF, 46.40% ± 4.61%) were observed in cycles with higher SDF, despite similar pregnancy rates (≥30% SDF, 30.40% vs. <30% SDF, 32.40%). A 2.5-fold miscarriage rate was observed in cycles with an SDF above the established cutoff (≥30% SDF, 42.8% vs. <30% SDF, 16.8%).


Higher SDF is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in non–male factor infertility intracytoplasmic sperm injection cycles. Since defects in sperm may be hidden, the SDF test can bring additional information to the sperm quality evaluation of men with unknown infertility history.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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