In vitro fertilization-intracytoplasmic sperm injection outcome in patients with a markedly high DNA fragmentation index (> 50%)

Objective: To investigate differences in fertilization, clinical pregnancy, and miscarriage rates between men with a markedly high sperm DNA fragmentation index (DFI) (> 50%) and those with low DFI (<= 15%) in couples matched by female partner age and ovarian reserve as determined by antimullerian hormone (AMH) level. Design: Retrospective cohort study. Setting: University-affiliated fertility center. Patient(s): Men undergoing intracytoplasmic sperm injection (ICSI) cycles who had low (n = 114) or markedly high (n = 36) DNA damage. Intervention(s): None. Main Outcome Measure(s): Sperm DNA damage evaluated by acridine orange flow cytometry and expressed as the DFI, with the potential confounders of ovarian reserve and age controlled for by multivariable logistic regression analysis. Result(s): The fertilization and clinical pregnancy rates were not different between the two groups. We observed a trend toward a higher miscarriage rate with the high DFI group, but it did not reach statistical significance. Conclusion(s): Intracytoplasmic sperm injection in men with a high DFI with sperm selected by movement and morphology characteristics resulted in a similar pregnancy rate compared with the controls with a normal DFI. However, the trend observed of an increase in miscarriages suggests that any potential negative impact may appear later in development. Future studies involving a larger cohort may determine if the miscarriage trend reaches statistical significance. ((c) 2013 by American Society for Reproductive Medicine.)