Sperm DNA fragmentation is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in reproductive cycles of non–male factor infertility
High sperm DNA fragmentation indexes are correlated with poor embryo development, lower implantation rate, and higher miscarriage rates in couples undergoing intracytoplasmic sperm injection as a result of fe- male factor infertility.
Volume 112, Issue 3, Pages 483–490
Authors:
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.
Abstract:
Objective
To study the implications of sperm DNA fragmentation (SDF) in intracytoplasmic sperm injection cycles for non–male factor infertility.
Design
Prospective cohort study.
Setting
Private university-affiliated IVF center.
Patient(s)
Data from 475 cycles performed from June 2016 to June 2017.
Intervention(s)
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.
Result(s)
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%).
Conclusion(s)
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.
Comments
This work represents a growing body of evidence on the role of elevated sperm DNA fragmentation rates on reproductive outcomes. What was the authors assay for sperm DNA fragmentation? Was it measured at the same lab?
There seems to be mounting evidence that elevated sperm DNA fragmentation is associated with poorer reproductive outcomes in IVF. But what do you recommend we do clinically if this test shows elevated DNA fragmentation?