The effect of sperm DNA fragmentation on <i>in vitro</i> fertilization outcomes of unexplained infertility

Wang, Qingxin; Gu, Xiaoling; Chen, Yannan; Yu, Minyan; Peng, Lingna; Zhong, Shuping; Wang, Xia; Lv, Jinxing

doi:10.1016/j.clinsp.2023.100261

Brasil

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Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100261 linkcopy

The effect of sperm DNA fragmentation on in vitro fertilization outcomes of unexplained infertility

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Infertility is caused by heterogeneous risks, but most of them are unexplained.
Sperm DFI diagnostic value was controversial as not rule out male sperm parameters.
Whether DFI was a useful indicator for embryologists and clinicians in UEI couples.

Abstract

Background Infertility is caused by heterogeneous risks, but most of them are unexplained. The sperm DNA Fragmentation Index (DFI) was increasingly acknowledged as a parameter for the evaluation of male infertility. This study aimed to investigate the association between sperm DFI and laboratory and clinical outcomes in a population with unexplained infertility.

Methods The clinical data of an infertile population was collected for the selection of reproductive patients with unexplained infertility. The authors classified the patients with normal sperm parameters in a control group (DFI < 25%) and an observation group (DFI ≥ 25%) and compared the difference in basal characteristics, laboratory, and clinical outcomes between the two groups. The authors conducted a correlation analysis to examine the relationship between DFI and the number of D3 good-quality embryos, as well as the clinical pregnancy rate and live birth rate. A total of 176 cases were enrolled in the retrospective study.

Results The observation group (n = 88) showed advanced male age, lower sperm concentration, progressive motility, and morphology assessment than the control group. In addition, lower No. of D3 good-quality embryos, clinical pregnancy rate, and the live birth rate were shown in the observation group. A negative correlation between the DFI and No. of D3 good-quality embryos (rs = -0.347, p < 0.001) or live birth rate (rs = -0.185, p = 0.028) was shown.

Conclusions Sperm DFI was a good indicator for the prediction of D3 good-quality embryos in unexplained infertility couples, but it did not provide sufficient information regarding clinical pregnancy outcome but live pregnancy outcome.

Keywords Unexplained infertility; Sperm DNA fragmentation index; D3 good-quality embryos; Live birth rate

Variable	Control group (n = 88)	Observation group (n = 88)	χ²/U value	p-value
Female age (years)	28 (26∼30)	30 (28∼35)	5339.5	<0.001
Female BMI (kg/m²)	21 (19∼23)	22.5 (20.6∼24.5)	4980.5	0.001
Basal FSH levels (IU/L)	6.5 (5.3∼7.4)	6.9 (5.9∼8.5)	4710.5	0.013
Basal LH levels (IU/L)	4.3 (3.4∼5.8)	4.2 (2.8∼5.8)	3534.5	0.318
Basal E₂ levels (pg/mL)	46.4 (39.3∼57.3)	37.0 (27.0∼52.7)	2547.0	<0.001
Total gonadotropin dose (IU)	1725.0 (1500.0∼2006.3)	1800.0 (1425.0∼2081.3)	3963.0	0.787
No. of days of stimulation	7 (7∼8)	8 (7∼8)	4255.5	0.242
E2 of hCG day (pg/mL)	2840.0 (2026.1∼3560.0)	2240.0 (1246.0∼3936.4)	3173.0	0.039
LH of hCG day (IU/L)	1.5 (1.0∼2.5)	2.4 (1.2∼3.8)	4988.5	<0.001
P of hCG day (ng/mL)	1.1 (0.8∼1.4)	0.9 (0.6∼1.4)	3344.0	0.117
Endometrial thickness (mm)	10.0 (8.9∼12.4)	10.6 (8.5∼12.0)	3739.0	0.694
No. of oocytes retrieved	9 (7∼14)	8 (5∼12)	3241.5	0.061
MII oocytes retrieved rate, (%)	100.0 (50.0∼100.0)	93.7 (50.0∼100.0)	3605.5	0.386
Male age (years)	29 (27∼31)	33 (29∼37)	5503.0	<0.001
Male BMI (kg/m²)	23.6 (20.8∼25.9)	24.2 (22.1∼26.0)	4372.5	0.138
Infertility duration (yr)	3 (2∼5)	4 (2∼5)	4164.5	0.384
Sperm concentration (*10⁶/mL)	64.0 (45.1∼89.2)	46.8 (28.1∼75.5)	2890.0	0.004
Progressive motility (%)	46.0 (40.0∼53.8)	37.5 (32.0∼48.0)	2272.5	<0.001
Sperm morphology (%)	6.0 (5.0∼7.0)	5.0 (4.0∼6.0)	2918.0	0.004
Sperm DFI (%)	10.0 (6.1∼14.0)	33.8 (29.3∼41.0)	7744.0	0.000
ART			42.764	<0.001
IVF	76 (86.4)	34 (38.6)
ICSI	12 (13.6)	54 (61.4)

Variables	rs	p-value
Clinical pregnancy rate per started cycle	-0.130	0.123
Live birth rate per started cycle	-0.185	0.028

	Control group (n = 88)	Observation group (n = 88)	χ²/U value	p-value
No. of 2PN embryo	4.5 (2.3∼7.0)	4.0 (2.0∼6.0)	3466.5	0.228
Normal fertilized embryo rate (%)	75.0 (51.8∼97.7)	70.3 (50.0∼91.7)	3697.5	0.154
No. of Cleavage embryo	4.5 (2.3∼7.0)	4.0 (2.0∼6.0)	3393.5	0.154
Cleavage embryo rate (%)	100.0 (100.0∼100.0)	100.0 (100.0∼100.0)	3507.0	0.113
No. of good quality embryo	2.5 (1.0∼4.8)	1.0 (0.0∼2.0)	2581.0	<0.001
Good quality embryo rate (%)	58.6 (28.6∼92.7)	25.0 (0.0∼62.4)	2744.5	<0.001
Number of embryo implantation
1, n (%)	12 (18.5)	17 (53.1)	12.293	<0.001
2, n (%)	53 (81.5)	15 (46.9)	12.293	<0.001
Frozen fertilized embryo implantation, n (%)	55 (84.6)	26 (81.3)	0.176	0.675
Biochemical pregnancy rate per started cycle, n (%)	6 (9.2)	5 (15.6)	0.872	0.350
Clinical pregnancy rate per started cycle, n (%)	37 (56.9)	9 (28.1)	7.132	0.008
Twin pregnancy rate per started cycle, n (%)	9 (14.3)	4 (12.9)	0.033	0.855
Miscarriages per started cycle, n (%)	6 (9.2)	3 (9.4)	0.001	0.982
Live birth rate per started cycle, n (%)	28 (43.1)	4 (12.5)	9.069	0.003

Variables	rs	p-value
Female age	-0.17	0.024
Female BMI	-0.152	0.044
Basal E2 levels	0.190	0.011
LH of hCG day	-0.085	0.263
Male age	-0.212	0.005
Sperm concentration	0.016	0.828
Progressive motility	0.255	<0.001
Sperm morphology	0.179	0.018
ART	-0.045	0.494

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