Li, F., Duan, X., Li, M., & Ma, X. (2024). Sperm DNA fragmentation index affect pregnancy outcomes and offspring safety in assisted reproductive technology. Scientific Reports, 14(1), 356. https://doi.org/10.1038/s41598-023-45091-6
Li F, Duan X, Li M, Ma X. Sperm DNA fragmentation index affect pregnancy outcomes and offspring safety in assisted reproductive technology. Sci Rep. 2024;14(1):356. doi:10.1038/s41598-023-45091-6
Li, Fei, et al. "Sperm DNA fragmentation index affect pregnancy outcomes and offspring safety in assisted reproductive technology." Scientific Reports, vol. 14, no. 1, 2024, pp. 356.
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Sperm DNA fragmentation is linked to more miscarriage in IVF and ICSI
A retrospective study of 6330 IVF and ICSI patients in China found that higher sperm DNA fragmentation was linked to more miscarriage and lower birth weight. Rates of fertilization, pregnancy, stillbirth, early birth and birth defects showed no significant difference.
Study at a glance, retrospective study of 6330 IVF and ICSI patients: Higher sperm DNA fragmentation was linked to more miscarriage. Source: Li F et al., 2024, PMID 38172506.
Key Findings
Patients were grouped by sperm DNA fragmentation index. IVF had 3123 patients below 15%, 561 at 15–30% and 46 at 30% or higher; ICSI had 1967, 462 and 171.
Miscarriage rates were significantly higher in IVF and ICSI patients with an index of 15–30% or above 30% than in those below 15% (P = 0.005).
In the ICSI group, miscarriage rates at an index above 30% were significantly higher than in the 15–30% group (P < 0.001).
A smooth fitting curve showed a positive correlation between miscarriage rates and sperm DNA fragmentation index (OR 1.095; 95% CI 1.068–1.123; P < 0.001).
Birth weight was significantly lower in the 15–30% and above-30% groups, and its curve showed a negative correlation with the index (OR 0.913; 95% CI 0.890–0.937; P < 0.001).
Interpretation
The study looked back at clinic records from two hospitals in China, from June 2013 to November 2020. It reports associations between the index and outcomes. The authors name selection bias and a Chinese-only patient group as limits and call for multicenter and randomized controlled trials. The IVF group with the highest index had 46 patients. The authors also note that guidelines do not endorse routine sperm DNA fragmentation testing, because the reliability of results may be compromised by sampling method, detection technique and reagents.
RRM Context
Restorative reproductive medicine evaluates both partners and looks for the cause of reduced sperm health. The authors name oxidative stress and varicocele as contributors to a high index. They cite reports that varicocele surgery lowers the index in most male patients. IVF and ICSI work with the sperm and eggs available and do not address why the index is high.
Our editorial summary of this paper, not the article's abstract.
Abstract
The role of sperm DNA fragmentation index (DFI) in investigating fertility, embryonic development, and pregnancy is of academic interest. However, there is ongoing controversy regarding the impact of DFI on pregnancy outcomes and the safety of offspring in the context of Assisted Reproductive Technology (ART). In this study, we conducted an analysis of clinical data obtained from 6330 patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at the reproductive medical center of The First People's Hospital of Shangqiu and The Affiliated Hospital of Zhengzhou University. The patients was stratified into two distinct groups: IVF group and ICSI group, Within each group, patients were further classified into three subgroups. IVF: group A (< 15%) included 3123 patients, group B (15-30%) included 561 patients, and group C (≥ 30%) included 46 patients. ICSI: group A (< 15%) included 1967 patients, group B (15-30%) included 462 patients, and group C (≥ 30%) included 171 patients. Data were collected and subjected to statistical analysis. There were no significant differences in the basic characteristics among the three groups, and the sperm DFI did not significantly affect the fertilization rates, pregnancy rates, stillbirth rates and the number of birth defects. However, the incidences of miscarriage rates in IVF/ICSI groups with DFI > 30% and DFI 15-30% were significantly higher than those in IVF/ICSI groups with DFI < 15%, and the miscarriage rates in ICSI group with DFI > 30% were significantly higher than DFI 15-30% group, the smooth fitting curve shows that there is a positive correlation between miscarriage rates and sperm DFI (OR 1.095; 95% CI 1.068-1.123; P < 0.001). The birth weight of infants in the IVF/ICSI groups with DFI > 30% and DFI 15-30% exhibited a statistically significant decrease compared to those in the IVF/ICSI groups with DFI < 15%. Furthermore, the birth weight of infants in the ICSI group with DFI > 30% was lower than that of the DFI 15-30% group. The smooth fitting curve analysis demonstrates a negative association between birth weight and sperm DFI (OR 0.913; 95% CI 0.890-0.937; P < 0.001). Sperm DFI has an impact on both miscarriage rates and birth weight in assisted reproductive technology. The smooth fitting curve analysis reveals a positive correlation between miscarriage rates and DFI, while a negative correlation is observed between birth weight and DFI.
