Sperm DNA Integrity Test and Assisted Reproductive Technology (Art) Outcome

Violeta S. Rilcheva 1 , Nina P. Ayvazova 2 , Lyubomira O. Ilieva 3 , Svetlana P. Ivanova 2 , and Emiliana I. Konova 4
  • 1 MC Clinical Institute for Reproductive Medicine - Pleven 20, Skobelevblvd. Pleven 5800, Bulgaria
  • 2 Institute of Biology and Immunology of Reproduction, Sofia, Bulgaria
  • 3 Institute of Biology and Immunology of Reproduction, Sofia Bulgaria
  • 4 Center for Reproductive Health, Medical University - Pleven, Bulgaria


The objective of the study was to investigate the influence of sperm DNA fragmentation index (DFI) by DNA integrity test on pregnancy outcome and pregnancy loss after assisted reproductive technology (ART) procedure: autologous intracytoplasmic sperm injection (ICSI), donation eggs ICSI, and intrauterine insemination (IUI). We investigated men from 531 couples undergoing autologous ICSI procedure (n=416), from couples undergoing donation eggs procedure (n=39) and IUI (n=76). We performed the following interventions: semen analysis, DNA integrity test, embryo scoring by Gardner and Schoolcraft grading system (1999). The study showed no statistically significant differences between the group regarding pregnancy rate (χ2=0.55; p>0.05; OR=1.25, 95% Cl 1.23-1.46; p>0.05). However, with increased levels of DFI, the number of pregnancy losses became higher (including biochemical pregnancies and spontaneous abortions) at OR=5.65 (95% Cl 4.32-7.11; p=0.05). We examined the percentage of grade I blastocysts (by Gardner and Schoolcraft, 1999) before donation eggs embryo transfer and found a statistically significant correlation with both the DFI (χ2=7.80; p<0.05) and sperm morphology (χ2=6.14; p<0.05). Analysis of the relationship between DFI and IUI output (clinical pregnancy, miscarriage) revealed significant correlations in both directions: between DFI and pregnancy rate after IUI (χ2=6.29; p<0.05) and between the DFI and pregnancy development after IUI (χ2=6.87; p<0.05). The three group categories (autologous, heterologous ICSI procedures and IUI) studied showed that sperm samples with DFI>27% were associated with increased riskofearlypregnancyloss. Men with infertility should undergo DNA fragmentation assay in addition to the standard semen analysis. When DFI exceeds 27%, ICSI should be a method of choice, even in cases where the conventional parameters of semen analysis tests are normal.

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