Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis

Objective: To investigate the rate of sperm DNA fragmentation in male partners of women with recurrent pregnancy loss and fertile control women. Design: Systematic review and meta-analysis. Setting: Not applicable. Patient(s): A total of 579 male partners of women with recurrent pregnancy loss and 434 male partners fertile control women. Intervention(s): Prospective studies were identified through a Pubmed search. Recurrent pregnancy loss was defined as two or more previous pregnancy losses. Fertile control women had a history of a live birth or ongoing pregnancy. Main Outcome Measure(s): The primary outcome was the rate of sperm DNA fragmentation. The summary measures were reported as mean difference with 95% confidence interval (CI). Result(s): Fifteen prospective studies were included in a qualitative review. Pooled data from 13 studies with sufficient data for meta-analysis suggest that male partners of women with a history of recurrent pregnancy loss have a significantly higher rate of sperm DNA fragmentation compared to the partners of fertile control women: mean difference 11.91, 95% CI 4.97-18.86. Conclusion(s): These findings support an association between sperm DNA fragmentation and recurrent pregnancy loss. However, given the significant heterogeneity between studies and lack of prospective pregnancy outcome data, further large prospective studies are needed. ((C) 2019 by American Society for Reproductive Medicine.)