Sperm deoxyribonucleic acid fragmentation as a prognostic indicator of assisted reproductive technology outcome.
OBJECTIVE
To examine sperm DNA fragmentation in semen used for assisted reproduction procedures to establish this factor's prognostic role in fertilization rate, embryo development, pregnancy rate, and outcome.


METHODS
Prospective study.


METHODS
Department of Medicine and Biology of Reproduction of the Edouard Herriot Hospital in Lyon, France.


METHODS
322 couples, divided into 88 cycles of in vitro fertilization (IVF) or 234 cycles of intracytoplasmic sperm injection (ICSI).


METHODS
Sperm DNA fragmentation was detected in sperm obtained 2 to 5 months before the ART procedure.


METHODS
Sperm DNA fragmentation was measured with the terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling (TUNEL) technique.


RESULTS
There was a negative statistical correlation between the rate of fragmentation and the semen characteristics. A statistically significant negative relationship was found for sperm DNA fragmentation and fertilization when ICSI and IVF were compared. With ICSI, a statistically significant negative relationship was found between fertilization rate and percentage of sperm DNA fragmentation (DNA fragmentation index, or DFI). The risk of nontransfer due to blocked embryo development increased when the DFI exceeded 15% (18.2% for ICSI vs 4.2% for IVF) with an odds ratio of 5.05. The miscarriage risk increased fourfold when the DFI exceeded 15% (37.5% for ICSI vs 8.8% for IVF).


CONCLUSIONS
Sperm DNA fragmentation measured 2 to 5 months before the assisted reproduction procedure was a prognostic indicator of the fertilization, pregnancy, and miscarriage rates and the pregnancy outcome.
Benchaib
Mehdi
M
Département de Médecine de la Reproduction, Hôpital Edouard Herriot, France. mehdi.benchaib@sante.univ-lyon1.fr
Lornage
Jacqueline
J
Mazoyer
Claire
C
Lejeune
Herve
H
Salle
Bruno
B
François Guerin
Jean
J
D000328:Adult; D004247:DNA / Q000032:analysis / Q000235:genetics*; D053938:DNA Fragmentation; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013094:Spermatozoa / Q000378:metabolism*; D016896:Treatment Outcome
D004247:DNA