title: Do sperm DNA integrity tests predict pregnancy with in vitro fertilization?
abstract: OBJECTIVE
  To evaluate the predictive value of sperm DNA integrity tests for pregnancy from in vitro fertilization treatment.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Studies from infertility centers.
  
  
  METHODS
  Infertile couples undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment.
  
  
  METHODS
  Sperm DNA integrity tests before IVF and ICSI cycles.
  
  
  METHODS
  Diagnostic test properties for sperm DNA integrity tests with reference to pregnancy after IVF or ICSI treatment.
  
  
  RESULTS
  Among 22 relevant studies, 2 x 2 tables were constructed from 13 studies involving 18 estimates of the diagnostic test properties of sperm DNA integrity tests in 2162 cycles of treatment. The sum of sensitivity and specificity ranged from 0.83 to 1.59. In six of 18 estimates abnormal DNA integrity was associated with a higher than expected pregnancy rate. The summary diagnostic odds ratio was 1.44 (95% CI, 1.03, 2.03), but the summary likelihood ratios (LR) were not predictive of pregnancy outcome (LR+ = 1.23; 95% CI, 0.98, 1.54; LR- = 0.81; 95% CI, 0.67, 0.98). Neither sperm chromatin structure assay nor terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay tests were more predictive of pregnancy outcome after IVF/ICSI, and DNA integrity testing was not more predictive for IVF than ICSI.
  
  
  CONCLUSIONS
  The small but statistically significant association between sperm DNA integrity test results and pregnancy in IVF and ICSI cycles is not strong enough to provide a clinical indication for routine use of these tests in infertility evaluation of men. It is possible that yet to be determined subgroups of infertile couples may benefit from sperm DNA integrity testing.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada. collins@mcmaster.ca
authors.forename: John A
authors.initials: JA
authors.lastname: Collins
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Barnhart
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
mesh_terms: D002843:Chromatin / Q000737:chemistry*; D053938:DNA Fragmentation; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D020287:In Situ Nick-End Labeling; D007246:Infertility / Q000235:genetics / Q000628:therapy*; D016013:Likelihood Functions; D008297:Male; D025202:Molecular Diagnostic Techniques; D015394:Molecular Structure; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D012680:Sensitivity and Specificity; D020554:Sperm Injections, Intracytoplasmic; D013094:Spermatozoa / Q000737:chemistry / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D002843:Chromatin