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Sperm DNA fragmentation index and pregnancy outcome after IVF or ICSI: a meta-analysis

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The purpose of this study was to carry out a meta-analysis for a comprehensive understanding and estimation of the association between sperm DNA Fragmentation Index (DFI) and pregnancy outcome after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.


Studies concerning the link of DFI with pregnancy outcome were included after literature search of database PUBMED, EMBASE, MEDLINE. Related information was extracted from the eligible studies by two independent authors and a meta-analysis was conducted by using STATA 12.0 software. Pregnancy outcomes consisted of biochemical pregnancy (BP), clinical pregnancy (CP) and pregnancy loss (PL). The studies included for meta-analysis were divided into three groups according to the DFI threshold value (DFI >27 %, 15–27 %, ≤15 % group). The odds ratio (OR ) and their 95 % confidence intervals (95 % CIs) were used to evaluate the association between DFI and pregnancy outcome.


Twenty articles were included in our meta-analysis. The results indicated that infertile couples were more likely to get pregnant if DFI was less than threshold value (For threshold value > 27 % and 15–27 % group, combined overall OR (95 % CI) = 1.437 (1.186–1.742), 1.639 (1.093–2.459) respectively). However, when stratified by DFI detection methods, using sperm chromatin structure assay (SCSA) as the DFI test method, the results indicated a similar CP rate between groups with a high DFI or a lower DFI value (SCSA, For threshold value >27 % and 15–27 % group, combined overall OR (95 % CI) = 1.242(0.978–1.577), 1.480(0.921–2.377) respectively). The meta-analysis based on BP (overall OR (95 % CI) = 0.952 (0.697–1.302)) and PL((For DFI >27 %, 15–27 %, ≤15 % group, OR (95 % CI) = 0.786 (0.491–1.258), 1.509 (0.655–3.476), (0.538 (0.264–1.097) respectively) outcome yielded nonsignificant results.


The predication value of DFI for IVF or ICSI outcome is not confirmed in our meta-analysis. Further better designed studies with larger subjects involved are needed to better address this issue.

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  1. Katz P, Nachtigall R, Showstack J. The economic impact of the assisted reproductive technologies. Nat Cell Biol. 2002;4:29–32.

    Article  Google Scholar 

  2. Agarwal A, Allamaneni SS. The effect of sperm DNA damage on assisted reproduction outcomes. A review. Minerva Ginecol. 2004;56:235–45.

    CAS  PubMed  Google Scholar 

  3. Shamsi MB, Kumar R, Dada R. Evaluation of nuclear DNA damage in human spermatozoa in men opting for assisted reproduction. Indian J Med Res. 2008;127:115–23.

    CAS  PubMed  Google Scholar 

  4. Evenson D, Wixon R. Meta-analysis of sperm DNA fragmentation using the sperm chromatin structure assay. Reprod Biomed Online. 2006;12:466–72.

    Article  CAS  PubMed  Google Scholar 

  5. Collins JA, Barnhart KT, Schlegel PN. Do sperm DNA integrity tests predict pregnancy with in vitro fertilization? Fertil Steril. 2008;89:823–31.

    Article  PubMed  Google Scholar 

  6. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  7. Benchaib M, Lornage J, Mazoyer C, Lejeune H, Salle B, François GJ. Sperm deoxyribonucleic acid fragmentation as a prognostic indicator of assisted reproductive technology outcome. Fertil Steril. 2007;87:93–100.

    Article  CAS  PubMed  Google Scholar 

  8. Boe-Hansen GB, Fedder J, Ersbøll AK, Christensen P. The sperm chromatin structure assay as a diagnostic tool in the human fertility clinic. Hum Reprod. 2006;21:1576–82.

    Article  PubMed  Google Scholar 

  9. Bungum M, Humaidan P, Spano M, Jepson K, Bungum L, Giwercman A. The predictive value of sperm chromatin structure assay (SCSA) parameters for the outcome of intrauterine insemination, IVF and ICSI. Hum Reprod. 2004;19:1401–8.

    Article  CAS  PubMed  Google Scholar 

  10. Bungum M, Humaidan P, Axmon A, Spano M, Bungum L, Erenpreiss J, et al. Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome. Hum Reprod. 2007;22:174–9.

    Article  CAS  PubMed  Google Scholar 

  11. Bungum M, Spanò M, Humaidan P, Eleuteri P, Rescia M, Giwercman A. Sperm chromatin structure assay parameters measured after density gradient centrifugation are not predictive for the outcome of ART. Hum Reprod. 2008;23:4–10.

    Article  CAS  PubMed  Google Scholar 

  12. Chi HJ, Chung DY, Choi SY, Kim JH, Kim GY, Lee JS, et al. Integrity of human sperm DNA assessed by the neutral comet assay and its relationship to semen parameters and clinical outcomes for the IVF-ET program. Clin Exp Reprod Med. 2011;38:10–7.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Gandini L, Lombardo F, Paoli D, Caruso F, Eleuteri P, Leter G, et al. Full-term pregnancies achieved with ICSI despite high levels of sperm chromatin damage. Hum Reprod. 2004;19:1409–17.

    Article  CAS  PubMed  Google Scholar 

  14. Kennedy C, Ahlering P, Rodriguez H, Levy S, Sutovsky P. Sperm chromatin structure correlates with spontaneous abortion and multiple pregnancy rates in assisted reproduction. Reprod Biomed Online. 2011;22:272–6.

    Article  CAS  PubMed  Google Scholar 

  15. Lin MH, Kuo-Kuang Lee R, Li SH, Lu CH, Sun FJ, et al. Sperm chromatin structure assay parameters are not related to fertilization rates, embryo quality, and pregnancy rates in in vitro fertilization and intracytoplasmic sperm injection, but might be related to spontaneous abortion rates. Fertil Steril. 2008;90:352–9.

    Article  PubMed  Google Scholar 

  16. Miciński P, Pawlicki K, Wielgus E, Bochenek M, Tworkowska I. The sperm chromatin structure assay (SCSA) as prognostic factor in IVF/ICSI program. Reprod Biol. 2009;9:65–70.

    Article  PubMed  Google Scholar 

  17. Niu ZH, Shi HJ, Zhang HQ, Zhang AJ, Sun YJ, Feng Y. Sperm chromatin structure assay results after swim-up are related only to embryo quality but not to fertilization and pregnancy rates following IVF. s. 2011;13:862–6.

    Google Scholar 

  18. Payne JF, Raburn DJ, Couchman GM, Price TM, Jamison MG, Walmer DK. Redefining the relationship between sperm deoxyribonucleic acid fragmentation as measured by the sperm chromatin structure assay and outcomes of assisted reproductive techniques. Fertil Steril. 2005;84:356–64.

    Article  PubMed  Google Scholar 

  19. Henkel R, Kierspel E, Hajimohammad M, Stalf T, Hoogendijk C, Mehnert C, et al. DNA fragmentation of spermatozoa and assisted reproduction technology. Reprod Biomed Online. 2003;7:477–84.

    Article  PubMed  Google Scholar 

  20. Henkel R, Hajimohammad M, Stalf T, Hoogendijk C, Mehnert C, Menkveld R, et al. Influence of deoxyribonucleic acid damage on fertilization and pregnancy. Fertil Steril. 2004;81:965–72.

    Article  CAS  PubMed  Google Scholar 

  21. Zhang Y, Wang H, Wang L, Zhou Z, Sha J, Mao Y, et al. The clinical significance of sperm DNA damage detection combined with routine semen testing in assisted reproduction. Mol Med Rep. 2008;1:617–24.

    CAS  PubMed  Google Scholar 

  22. Zini A, Meriano J, Kader K, Jarvi K, Laskin CA, Cadesky K. Potential adverse effect of sperm DNA damage on embryo quality after ICSI. Hum Reprod. 2005;20:3476–80.

    Article  CAS  PubMed  Google Scholar 

  23. Dar S, Grover SA, Moskovtsev SI, Swanson S, Baratz A, Librach CL. In vitro fertilization-intracytoplasmic sperm injection outcome in patients with a markedly high DNA fragmentation index (>50 %). Fertil Steril. 2013;100:75–80.

    Article  PubMed  Google Scholar 

  24. Speyer BE, Pizzey AR, Ranieri M, Joshi R, Delhanty JD, Serhal P. Fall in implantation rates following ICSI with sperm with high DNA fragmentation. Hum Reprod. 2010;25:1609–18.

    Article  CAS  PubMed  Google Scholar 

  25. Jiang HH, He XJ, Song B, Cao YX. Sperm chromatin integrity test for predicting the outcomes of IVF and ICSI. Zhonghua Nan Ke Xue. 2011;17:1083–6.

    PubMed  Google Scholar 

  26. Yang XY, Wang LL, Chen P, Zhang Y, Zhang W, Cui YG, et al. Impact of sperm DNA fragmentation index and sperm malformation rate on the clinical outcome of ICSI. Zhonghua Nan Ke Xue. 2013;19:1082–6.

    PubMed  Google Scholar 

  27. Venkatesh S, Singh A, Shamsi MB, Thilagavathi J, Kumar R, Mitra DK, et al. Clinical significance of sperm DNA damage threshold value in the assessment of male infertility. Reprod Sci. 2011;18:1005–13.

    Article  CAS  PubMed  Google Scholar 

  28. Van Kooij RJ, de Boer P, De Vreeden-Elbertse JM, Ganga NA, Singh N, Te Velde ER. The neutral comet assay detects double strand DNA damage in selected and unselected human spermatozoa of normospermic donors. Int J Androl. 2004;27:140–6.

    Article  PubMed  Google Scholar 

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The study was supported by the National Natural Science Foundation of China (No. 81170563 and 81270694).

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All authors declare no competing financial interests.

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Correspondence to Yutian Dai.

Additional information

Capsule DFI is an important value to assess human sperm quality, but this meta-analysis found no association between DFI and pregnancy outcome after IVF or ICSI.

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Zhang, Z., Zhu, L., Jiang, H. et al. Sperm DNA fragmentation index and pregnancy outcome after IVF or ICSI: a meta-analysis. J Assist Reprod Genet 32, 17–26 (2015).

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