RESUMEN
BACKGROUND: Infertility is caused by heterogeneous risks, but most of them are unexplained. The sperm DNA Fragmentation Index (DFI) was increasingly acknowledged as a parameter for the evaluation of male infertility. This study aimed to investigate the association between sperm DFI and laboratory and clinical outcomes in a population with unexplained infertility. METHODS: The clinical data of an infertile population was collected for the selection of reproductive patients with unexplained infertility. The authors classified the patients with normal sperm parameters in a control group (DFI < 25%) and an observation group (DFI ≥ 25%) and compared the difference in basal characteristics, laboratory, and clinical outcomes between the two groups. The authors conducted a correlation analysis to examine the relationship between DFI and the number of D3 good-quality embryos, as well as the clinical pregnancy rate and live birth rate. A total of 176 cases were enrolled in the retrospective study. RESULTS: The observation group (n = 88) showed advanced male age, lower sperm concentration, progressive motility, and morphology assessment than the control group. In addition, lower No. of D3 good-quality embryos, clinical pregnancy rate, and the live birth rate were shown in the observation group. A negative correlation between the DFI and No. of D3 good-quality embryos (rs = -0.347, p < 0.001) or live birth rate (rs = -0.185, p = 0.028) was shown. CONCLUSIONS: Sperm DFI was a good indicator for the prediction of D3 good-quality embryos in unexplained infertility couples, but it did not provide sufficient information regarding clinical pregnancy outcome but live pregnancy outcome.
Asunto(s)
Infertilidad Masculina , Semen , Femenino , Humanos , Masculino , Embarazo , Fragmentación del ADN , Estudios Retrospectivos , Fertilización In Vitro , Espermatozoides , Infertilidad Masculina/genética , Resultado del EmbarazoRESUMEN
Several studies show reductions in some seminal parameters in aged men and describe them as a consequence of many age-dependent changes in male organisms. This study aims to evaluate the impact of age on seminal parameters, particularly the DNA fragmentation index (DFI), and outcomes after in vitro fertilization (IVF) cycles. This is a retrospective study that includes 367 patients who underwent sperm chromatin structure assay testing between 2016 and 2021. The participants were split into three groups according to age: < 35 years (younger group, n = 63), 35-45 years (intermediate group, n = 227), and ≥ 45 years (older group, n = 77). The mean DFI (%) was compared. Among all patients, 255 received IVF cycles after DFI evaluation. For these patients, the sperm concentration, motility, and volume, as well as the fertilization rate, mean oocyte age, and good-quality blastocyst formation rate, were analyzed. One-way ANOVA was applied. The older group showed a significantly higher sperm than did the younger group (28.6% vs. 20.8% p = 0.0135). Despite not presenting a significant difference, the DFI level tends to be inversely related to good-quality blastocyst formation since the oocyte age was similar between the groups (32.0 v.s 33.6 vs. 32.3 years, respectively, p = 0.1183). Among aged men, the sperm DFI level is increased but other seminal parameters are not modified. Considering that men with a high sperm DFI can present some degree of infertility due to high sperm chromatin damage, male age should also be considered a limiting factor of IVF.
Asunto(s)
Edad Paterna , Semen , Masculino , Animales , Fragmentación del ADN , Estudios Retrospectivos , Espermatozoides , Fertilización In Vitro , Cromatina , BlastocistoRESUMEN
Abstract Background Infertility is caused by heterogeneous risks, but most of them are unexplained. The sperm DNA Fragmentation Index (DFI) was increasingly acknowledged as a parameter for the evaluation of male infertility. This study aimed to investigate the association between sperm DFI and laboratory and clinical outcomes in a population with unexplained infertility. Methods The clinical data of an infertile population was collected for the selection of reproductive patients with unexplained infertility. The authors classified the patients with normal sperm parameters in a control group (DFI < 25%) and an observation group (DFI ≥ 25%) and compared the difference in basal characteristics, laboratory, and clinical outcomes between the two groups. The authors conducted a correlation analysis to examine the relationship between DFI and the number of D3 good-quality embryos, as well as the clinical pregnancy rate and live birth rate. A total of 176 cases were enrolled in the retrospective study. Results The observation group (n = 88) showed advanced male age, lower sperm concentration, progressive motility, and morphology assessment than the control group. In addition, lower No. of D3 good-quality embryos, clinical pregnancy rate, and the live birth rate were shown in the observation group. A negative correlation between the DFI and No. of D3 good-quality embryos (rs = -0.347, p < 0.001) or live birth rate (rs = -0.185, p = 0.028) was shown. Conclusions Sperm DFI was a good indicator for the prediction of D3 good-quality embryos in unexplained infertility couples, but it did not provide sufficient information regarding clinical pregnancy outcome but live pregnancy outcome.
RESUMEN
Introducción: El análisis de espermatograma es utilizado como una prueba diagnóstica de la calidad seminal. Recientemente, el análisis de fragmentación espermática ha tomado importancia dado los diversos estudios que han demostrado que la integridad del ADN en el espermatozoide afectaría los resultados clínicos en los tratamientos de reproducción asistida. Objetivos: Identificar las variables analizadas en un espermatograma que predecirían independientemente el índice de fragmentación de ADN espermático (IFE). Diseño: Estudio retrospectivo, comparativo. Instituciones: Grupo PRANOR, Reprogenetics Latinoamerica, Clínica Concebir, Lima, Perú. Material biológico: Espermatozoides. Métodos: Se comparó variables individuales y dos modelos: el primero consideró el porcentaje de vialidad espermática y la edad del paciente; el segundo modelo incluyó el porcentaje de espermatozoides motiles y la edad. Se hizo análisis de regresión logística. Principales medidas de resultados: Viabilidad espermática, edad. Resultados: El análisis multivariado demostró que los dos modelos fueron significantemente superiores a las variables individuales (p<0,01). El primer modelo tuvo valores de coeficiente no estandarizados (IC95%) de 0,200 (0,082 a 0,318) y -0,146 (-0,206 a -0,086), respectivamente. El segundo modelo tuvo valores de coeficiente no estandarizados (IC95%) de -0,099 (-0,157 a -0,042) y 0,219 (0,99 a 0,339), respectivamente. El análisis de regresión logística demostró que el porcentaje de viabilidad espermática y la edad del paciente predijeron la probabilidad de tener un IFE superior al 30% con valores de coeficiente no estandarizados de edad de IC95% 0,034 (0,015 a 0,053) y porcentaje de viabilidad de -0,043 (0,034 a 0,052). Adicionalmente, el segundo modelo tuvo IC95% de -0,04 (-0,031 a -0,049) y 0,035 (0,017 a 0,053), respectivamente. Finalmente, una curva ROC construida para determinar la superioridad de algún modelo sobre las variables individuales demostró que las áreas bajo la curva (ABC) del modelo 1 (edad y viabilidad espermática) fue 0,727 (IC95% = 0,665 a 0,790) y el modelo 2 (edad y motilidad total de espermatozoides) 0,675 (IC95% = 0,606 a 0,744), comparadas con las ABC del porcentaje de viabilidad espermática = 0,295 (IC95% = 0,229 a 0,362), motilidad total de espermatozoides ABC = 0,333 (IC95% = 0,264 a 0,403) y edad de paciente con ABC 0,584 (IC95% = 0,510 a 0,658). Conclusiones: La edad, motilidad y viabilidad espermática correlacionaron de manera independiente con el IFE y, por tanto, estas variables podrían ser usadas como predictores del porcentaje de fragmentación de ADN.
Introduction: The spermatogram is used as a test of seminal quality. Recently, the sperm fragmentation test has demonstrated importance as sperm DNA integrity would affect clinical results in assisted reproduction treatments. Objectives: To determine spermatogram variables that would independently predict sperm DNA fragmentation index (SFI). Design: Retrospective, comparative study. Settings: Grupo PRANOR, Reprogenetics Latinoamerica, Clinica Concebir, Lima, Peru. Biologic material: Sperm. Methods: Individual variables and two models were compared: the first model considered percentage of sperm viability and patients age; the second model included percentage of motile sperms and age. Logistic regression analysis was done. Main outcome measures: Sperm viability, age. Results: Multivariate analysis showed that both models were significantly superior to individuals variables (p<0.01). The first model had non standardized coefficient values (95%CI) respectively of 0.200 (0.082 to 0.318) and -0.146 (-0.206 to -0.086). The second model had non standardized coefficient values (95%CI) respectively of -0.099 (-0.157 to -0.042) and 0.219 (0.99 to 0.339). Logistic regression analysis showed that the percentage of sperm viability and patients age predicted the probability of having an SFI over 30% with age non standardized coefficient values of 95%IC 0.034 (0.015 to 0.053) and viability percentage of -0.043 (0.034 to 0.052). Additionally the second model had 95%CI respectively of -0.04 (-0.031 to -0.049) and 0.035 (0.017 to 0.053). Finally, a ROC curve to determine the superiority of some model over individual variables showed that areas under the curve (ABC) of model 1 (age and sperm viability) was 0.727 (95%CI = 0.665 to 0.790) and model 2 (age and sperm total motility) 0.675 (95%CI = 0.606 to 0.744), compared with ABC of percentage of sperm viability = 0.295 (95%CI = 0.229 to 0.362), sperm total motility ABC = 0.333 (95%CI = 0.264 to 0.403) and patients age with ABC 0.584 (95%CI = 0.510 to 0.658). Conclusions: Age, and sperm motility and viability independently correlated with SFI and consequently these variables could be used as predictors of DNA fragmentation percentage.