Research and Reports in Urology (Jun 2021)
Predictive Significance of Sperm DNA Fragmentation Testing in Early Pregnancy Loss in Infertile Couples Undergoing Intracytoplasmic Sperm Injection
Abstract
Minh Tam Le,1,2 Trung Van Nguyen,1 Thai Thanh Thi Nguyen,1 Hiep Tuyet Thi Nguyen,1 Duong Dinh Le,3 Vu Quoc Huy Nguyen2 1Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; 2Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; 3Department of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, VietnamCorrespondence: Minh Tam LeCenter for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, Hue City, VietnamTel +84 989228779Email [email protected]: This study aimed to determine the role of sperm DNA fragmentation as a marker that could predict early pregnancy loss (EPL), either independently or in combination with another marker or markers, after intracytoplasmic sperm injection (ICSI) cycles.Methods: This prospective descriptive cohort study retrieved data from 162 couples who underwent their first ICSI cycles at the Center for Reproductive Endocrinology and Infertility of Hue University Hospital in Vietnam from May 2018 to December 2019. General characteristics, semen parameters, sperm DNA fragmentation index (DFI), fertilization, embryo development, pregnancy rates, and EPL were assessed. The receiver-operating characteristic (ROC) method was performed to identify the threshold of DFI in EPL. Multivariate analysis was used to demonstrate the relationship between the sperm DNA fragmentation level and EPL.Results: Of 162 ICSI cycles, 23 (14.2%) involved EPL. There was no significant difference between the sperm DNA fragmentation rate and the overall rate of pregnancy loss, although the negative pregnancy outcome group had a median DFI that was higher than that of the positive pregnancy outcome group (20% vs 17.8%). The ROC analysis indicated that a sperm DNA fragmentation rate of 16.6% was the priority cut-off that could be used to distinguish EPL with a sensitivity of 73.9% (95% confidence interval [CI], 67.15– 80.67) and specificity of 47.48% (95% CI, 39.79– 55.17). The multivariate analysis confirmed that in female factors such as age, body mass index (BMI), and sperm DNA fragmentation level affected the EPL rate. However, a combination of the sperm DNA fragmentation level and female age or female BMI could not sufficiently predict EPL.Conclusion: EPL can be affected by multiple factors including sperm DNA fragmentation; however, there is no sufficient evidence indicating that sperm DNA fragmentation, both as a single marker and combined with other markers, is a good predictor of EPL.Keywords: sperm DNA fragmentation, intracytoplasmic sperm injection, early pregnancy loss, infertility, assisted reproductive technology
