Association of sperm DNA fragmentation index with demographics, semen parameters and outcomes of infertile male with repeated intrauterine insemination failure referred for intracytoplasmic sperm injection: a cohort study

ABSTRACT

Objective. Integrity of sperm DNA was linked to successful intracytoplasmic sperm injection (ICSI) outcome. Sperm DNA fragmentation index (DFI) is a method to assess spermatozoa function and DNA damage. The current study examined DFI association with the demographic and seminal fluid parameters among males with mild oligo/asthenozoospermia, and we looked for clinical implications of DFI on the outcome of ICSI (in terms of fertilization rates, number of good quality embryos, and clinical pregnancy).
Patients and Methods. A prospective cohort study recruited 73 infertile couples with mild oligo athenospermia referred after repeated IUI failure for ICSI. Three sets of data were recorded: demographic criteria including male age, smoking status, and body mass index (BMI), Semen samples analyzed for standard seminal fluid analysis, and DFI, which was categorized into 3 sub-groups: ICSI outcome was recorded
Results. DFI was positively correlated with age and BMI. Motile and morphologically normal sperms correlated moderately and negatively to DFI (r = -0.45, -0.41). Progressively motile and morphologically normal sperm showed a moderate negative relationship to DFI (r = -0.45, -0.41) p < 0.0001, 0.03, sluggish and immotile sperm showed a weak positive statistically meaningful link to DFI (r = 0.3, 0.31). Low DFI cases had the highest fertilization rates and numbers of good-quality embryos. Moderate and high DFI categories were highest in the negative pregnancy group; p < 0.0001.
Conclusions. Meaningful link of DFI to infertile male demographic and seminal fluid parameters allows reducing modifiable factors and selecting best sperm candidate to improve ICSI outcome. Further studies are needed to unveil diagnostic, therapeutic and prognostic implication of DFI.