title: Predictive value of sperm deoxyribonucleic acid (DNA) fragmentation index in male infertility.
abstract: BACKGROUND
  Recently, damage to the sperm DNA has been studied as it is associated with reduced fertilization rates, embryo quality, and pregnancy rates, also higher rates of spontaneous miscarriage.
  
  
  OBJECTIVE
  To develop a diagnostic method in predicting male infertility.
  
  
  METHODS
  The design of this study is cross-sectional. Data were retrieved from medical records of Yasmin IVF Clinic Dr. Cipto Mangunkusumo General Hospital and Daya Medika Infertility Clinic from January to December 2015. Subjects were selected by consecutive sampling and divided into two groups: infertile and fertile. Sperm deoxyribonucleic acid fragmentation index (DFI) was determined by sperm chromatin dispersion (SCD) method using Halosperm® Kit.
  
  
  RESULTS
  There were 114 subjects (36 fertile and 78 infertile) selected into this study. We found no significant difference in the age between both of groups. The median value of sperm DFI in infertile group was significantly higher, 29.95 (26.6-34.3)%, compared to 19.90 (15.6-24.4)% of the fertile group, withp< 0.001. Area Under Curve (AUC) of sperm DFI, 0.862 (95% CI 0.783, 0.941), was higher than concentration (AUC 0.744; 95% CI 0.657, 0.831), motility (AUC 0.668; 95% CI 0.572, 0.765), and morphology (AUC 0.718; 95% CI 0.697, 0.864) of the semen analysis. At the cut-off point of 26.1%, the sperm DFI had sensitivity of 80.8% (95% CI; 70.0, 88.5), specificity of 86.1% (95% CI; 69.7, 94.8), positive predictive value (PPV) of 92.6% (95% CI; 83.0, 97.3), negative predictive value (NPV) of 67.4% (95% CI; 51.9, 80.0), positive likelihood ratio (PLR) of 12.6 (95% CI; 5.4, 29.4), and negative likelihood ratio (NLR) of 0.48 (95% CI 0.31, 0.75). Sperm DFI of ≥26.1% had prevalence ratio of 2.84 (95% CI 1.86, 4.33) for the occurrence of male infertility.
  
  
  CONCLUSIONS
  There was significant difference between the median value of sperm DFI of infertile men and fertile men. Compared to semen analysis, sperm DFI at cut-off point of 26.1% has a higher diagnostic value (AUC).
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Diponegoro no. 71, Central Jakarta, Indonesia.
authors.forename: Budi
authors.identifier: 0000-0002-5898-7034
authors.initials: B
authors.lastname: Wiweko
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Diponegoro no. 71, Central Jakarta, Indonesia.
authors.forename: Pramety
authors.initials: P
authors.lastname: Utami
keywords: Cut-off point; Halosperm®; Male infertility; Semen analysis; Sperm DNA fragmentation index; Sperm chromatin dispersion (SCD)