Introduction: Data continues to report sperm DNA fragmentation Index (DFI) testing as a useful tool in the evaluation of an infertile male. However, specific indications for DFI in couples with infertility remain unclear. To further evaluate specific indications for sperm DFI in clinical practice, we sought to investigate whether DFI and High DNA Stainability (HDS) evaluated by sperm chromatin structure assay (SCSA) predicts recurrent implantation failure (RIF), pregnancy rate, or live birth rates.
Methods: We performed a retrospective study evaluating couples who underwent Intracytoplasmic Sperm Injection (ICSI) or frozen embryo transfer cycles between January 2009 through December 2018. During that period, all consecutive couples undergoing ICSI underwent SCSA testing at one IVF center. We identified all couples that underwent at least 2 cycles during this time frame. Couples were excluded if they previously underwent ICSI, cycle canceled for any reason, as well as those using donor eggs. RIF was defined as = 2 failed cycles in couples with maternal age = 40 before = 12 weeks after transfer of =2 high quality embryos. We used logistic regression to explore the impact of DFI and HDS on spontaneous abortion, RIF and live birth while adjusting for relevant patient characteristics. Data analysis was performed in R 3.6.0 (R Core Team, Vienna, Austria).
Results: A total of 393 couples underwent 1202 cycles with a median pregnancy success and live birth rate of 36.9% and 20.6%, respectively. Mean (±standard deviation) female age was 34.0 ± 3.6 and a mean total motile sperm count of 68.1 ± 76.7 million. DFI and HDS were not associated with RIF (p=0.43, p=0.14, respectively), nor were they predictive of IVF success, defined as clinical pregnancy, in those with normal values of DFI and HDS when controlling for female age. DFI and HDS were not predictive for achieving a pregnancy (p=0.76 and p=0.96, respectively), nor was DFI predictive of spontaneous abortion (p=0.92). However, higher percentages of HDS were seen in live births vs. spontaneous abortion (12.4% vs 9.3%, p=0.003).
Conclusions: We found that neither sperm DFI nor HDS, as measured by SCSA, were predictive of RIF when controlling for female age and total motile sperm count. Further studies are needed to identify specific indications for sperm DFI testing. Source of