McQueen, D. B., Zhang, J., & Robins, J. C. (2019). Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis. Fertility and Sterility, 112(1), 54-60.e3. https://doi.org/10.1016/j.fertnstert.2019.03.003
McQueen DB, Zhang J, Robins JC. Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril. 2019;112(1):54-60.e3. doi:10.1016/j.fertnstert.2019.03.003
McQueen, Dana B., et al. "Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis." Fertility and Sterility, vol. 112, no. 1, 2019, pp. 54-60.e3.
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Sperm DNA fragmentation may be higher when couples have recurrent loss
Sperm DNA fragmentation appears higher in men whose partners have had recurrent pregnancy loss, a 2019 systematic review and meta-analysis reports. The review of prospective studies included 579 such men and 434 men whose partners were fertile. In the authors' view, the pooled data from 13 of the studies support an association.
Key Findings
A PubMed search found prospective studies, and the authors included 15 in a qualitative review, with 13 reporting enough data for the meta-analysis.
The review included 579 men whose partners had recurrent pregnancy loss, compared with 434 men whose partners were fertile control women.
Recurrent pregnancy loss meant two or more previous pregnancy losses, and a fertile control woman had a live birth or an ongoing pregnancy.
The 13 pooled studies suggest a significantly higher sperm DNA fragmentation rate in the recurrent pregnancy loss group than in fertile controls (mean difference 11.91, 95% confidence interval 4.97-18.86).
Interpretation
The synopsis draws on the abstract of a systematic review and meta-analysis, a study that gathers past research on one question and pools the results. The men in the studies were grouped by their partner's history of pregnancy, and the main measure was the sperm DNA fragmentation rate, meaning breaks in the sperm's DNA. The authors call for further large studies that follow couples forward. They point to the lack of prospective data on pregnancy outcomes.
RRM Context
RRM approaches recurrent pregnancy loss as a concern for both partners and looks for an underlying cause before treatment. The review places the male partner within that question through a sperm measure of breaks in the DNA he passes on to the embryo.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To investigate the rate of sperm DNA fragmentation in male partners of women with recurrent pregnancy loss and fertile control women.
Design
Systematic review and meta-analysis.
Setting
Not applicable.
Patients
A total of 579 male partners of women with recurrent pregnancy loss and 434 male partners fertile control women.
Interventions
Prospective studies were identified through a Pubmed search. Recurrent pregnancy loss was defined as two or more previous pregnancy losses. Fertile control women had a history of a live birth or ongoing pregnancy.
Main Outcome Measures
The primary outcome was the rate of sperm DNA fragmentation. The summary measures were reported as mean difference with 95% confidence interval (CI).
Results
Fifteen prospective studies were included in a qualitative review. Pooled data from 13 studies with sufficient data for meta-analysis suggest that male partners of women with a history of recurrent pregnancy loss have a significantly higher rate of sperm DNA fragmentation compared to the partners of fertile control women: mean difference 11.91, 95% CI 4.97-18.86.
Conclusions
These findings support an association between sperm DNA fragmentation and recurrent pregnancy loss. However, given the significant heterogeneity between studies and lack of prospective pregnancy outcome data, further large prospective studies are needed.
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