Predictive Significance of Sperm DNA Fragmentation Testing in Early Pregnancy Loss in Infertile Couples Undergoing Intracytoplasmic Sperm Injection

Minh Tam Le; Trung Van Nguyen; Thai Thanh Thi Nguyen; Hiep Tuyet Thi Nguyen; Duong Dinh Le; Vu Quoc Huy Nguyen

doi:10.2147/RRU.S315300

Predictive Significance of Sperm DNA Fragmentation Testing in Early Pregnancy Loss in Infertile Couples Undergoing Intracytoplasmic Sperm Injection

Res Rep Urol. 2021 Jun 1:13:313-323. doi: 10.2147/RRU.S315300. eCollection 2021.

Authors

Minh Tam Le^{1

2}, Trung Van Nguyen¹, Thai Thanh Thi Nguyen¹, Hiep Tuyet Thi Nguyen¹, Duong Dinh Le³, Vu Quoc Huy Nguyen²

Affiliations

¹ Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
² Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
³ Department of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.

Abstract

Objective: 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: assisted reproductive technology; early pregnancy loss; infertility; intracytoplasmic sperm injection; sperm DNA fragmentation.

Grants and funding

This work was supported by a research grant from Vietnam Ministry of Education and Training (grant num- ber DHH2018-04-78). The grantor had no influence in the content of the publication.