Sperm chromatin structure assay high DNA stainability sperm as a marker of early miscarriage after intracytoplasmic sperm injection

High DNA stainability, as determined by sperm chromatin structure assay, is a marker of increased risk of early miscarriage in intracytoplasmic sperm injection pregnancies.

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Volume 112, Issue 1, Pages 46–53.e2


Elsa Jerre, M.D., Mona Bungum, Ph.D., Donald Evenson, Ph.D., Aleksander Giwercman, M.D., Ph.D.



To determine whether high DNA stainability (HDS), as assessed by the sperm chromatin structure assay (SCSA), predicts the risk of early miscarriage after in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI).


Retrospective cohort study of consecutive pregnancies after IVF and ICSI treatment.


Reproductive medicine center.


A total of 1,602 pregnancies after 832 IVF and 770 ICSI treatments.


HDS measured using SCSA.

Main Outcome Measure(s)

Early miscarriage (≤12 weeks).


The HDS represents the proportion of immature spermatozoa lacking the normal exchange of histone for protamine-complexed DNA, and the outcome parameter was early miscarriage (≤12 weeks). For all treatments, the odds ratio (OR) and 95% confidence interval (CI) for early miscarriage was 1.41 (1.07–1.85) if HDS >15% compared with HDS ≤15%. When comparing the two HDS categories, for ICSI, the OR was 1.44 (1.01–2.04) whereas for IVF the results were not statistically significant.


There is a small but increased risk of early miscarriage if HDS >15% compared with HDS ≤15%. This increased risk is seen only after ICSI, not after IVF. These findings suggest that HDS can be used as a predictor of an increased risk of miscarriage in ICSI treatments.

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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.