Sperm deoxyribonucleic acid fragmentation assessment in normozoospermic male partners of couples with unexplained recurrent pregnancy loss A prospective study

Evaluation of the effect of sperm deoxyribonucleic acid fragmentation in male partners of couples with unexplained recurrent pregnancy loss compared with fertile men.

Gihan M. Bareh, M.D., Ph.D., Ethan Jacoby, B.A., Peter Binkley, B.S., Tien-cheng “Arthur” Chang, Ph.D., Robert S. Schenken, M.D., Randal D. Robinson, M.D.

Volume 105, Issue 2, Pages 329-336


To determine whether sperm DNA integrity in normozoospermic male partners plays a role in idiopathic recurrent pregnancy loss (RPL).

Prospective, cohort study.

Academic tertiary care center.

Group I: 26 male partners of women with unexplained RPL. Group II: 31 normozoospermic males with proven fertility.

Semen samples were collected by masturbation after 48–72 hours of abstinence. After liquefaction at room temperature, semen analysis was performed according to World Health Organization standards. Only samples with >20 × 106 spermatozoa/mL with at least 50% progressive sperm motility and 30 % normal morphology were selected for the study. DNA fragmentation of the sperm was assessed with TUNEL assay followed by flow cytometric analysis.

Main Outcome Measure(s):
Sperm DNA fragmentation in both groups.

Mean DNA fragmentation (mean ± SD) was significantly more in men with RPL (36.8 ± 5) compared with controls (9.4 ± 2.7).

Sperm DNA fragmentation may play a role in unexplained RPL despite normal semen analysis parameters.

  • In this study, men with normal semen analyses per WHO 1999 guidelines and had RPL had DNA fragmentation per TUNEL assessed compared to fertile controls. The DNA fragmentation was ~40% compared to ~10% of normal controls.

    This tells me several things:
    1. A normal semen analysis may not tell the whole story of a male’s infertility.
    2. If a couple experiences RPL, and the semen analysis is otherwise “normal,” additional testing needs to be considered.
    3. The couple may potentially benefit from undergoing ICSI with testicular sperm rather than ejaculated sperm.
    4. We need to find ways to improve sperm DNA fragmentation. Antioxidants? Fix a varicocele? Stop smoking?

    • Lotfi Bassa

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