In vitro fertilization intracytoplasmic sperm injection outcome in patients with a markedly high DNA fragmentation index greater than 50 percent

Capsule:
Similar fertilization and pregnancy rates were found in ICSI cycles involving men with markedly high DNA damage (DNA fragmentation index >50) compared with healthy men and controlled for partner variables.

Authors:
Shir Dar, M.D., Stephanie A. Grover, M.Sc., C.C.R.P., Sergey I. Moskovtsev, M.D., Ph.D., Sonja Swanson, M.Sc., Ari Baratz, M.D., Clifford L. Librach, M.D.

Volume 100, Issue 1, Pages 75-80, July 2013

Abstract:

Objective:
To investigate differences in fertilization, clinical pregnancy, and miscarriage rates between men with a markedly high sperm DNA fragmentation index (DFI) (>50%) and those with low DFI (≤15%) in couples matched by female partner age and ovarian reserve as determined by antimüllerian hormone (AMH) level.

Design:
Retrospective cohort study.

Setting:
University-affiliated fertility center.

Patient(s):
Men undergoing intracytoplasmic sperm injection (ICSI) cycles who had low (n = 114) or markedly high (n = 36) DNA damage.

Intervention(s):
None.

Main Outcome Measure(s):
Sperm DNA damage evaluated by acridine orange flow cytometry and expressed as the DFI, with the potential confounders of ovarian reserve and age controlled for by multivariable logistic regression analysis.

Result(s):
The fertilization and clinical pregnancy rates were not different between the two groups. We observed a trend toward a higher miscarriage rate with the high DFI group, but it did not reach statistical significance.

Conclusion(s):
Intracytoplasmic sperm injection in men with a high DFI with sperm selected by movement and morphology characteristics resulted in a similar pregnancy rate compared with the controls with a normal DFI. However, the trend observed of an increase in miscarriages suggests that any potential negative impact may appear later in development. Future studies involving a larger cohort may determine if the miscarriage trend reaches statistical significance.

  • Data hard to break down given the conglomeration of IVF and ICSI couples into a single data set. Statistical significance may have been reached with larger cohort in DFi >50 % or comparing IVF vs. IVF and ICSI vs. ICSI patients. However the data seems to correlate with prior studies.

    Was there male factor evaluation for etiology of elevated DFI? And if addressed and the DFI improved, did subsequent IVF/ICSI cycles result in better pregnancy and live birth rates?

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