BERKELEY, CA (UroToday.com) - DNA fragmentation as measured by terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling (TUNEL) technique in attempt to predict fertilization rate, embryo development, pregnancy rate, and outcome in 322 couples. 88 cycles of in vitro fertilization (IVF) or 234 cycles of intracytoplasmic sperm injection were carried out.

There was a negative statistical correlation between the rate of fragmentation and the semen characteristics. A statistically significant negative relationship was found for sperm DNA fragmentation and fertilization when ICSI and IVF were compared. With ICSI, a statistically significant negative relationship was found between fertilization rate and percentage of sperm DNA fragmentation (DNA fragmentation index, or DFI). The risk of nontransfer due to blocked embryo development increased when the DFI exceeded 15%. The miscarriage risk increased fourfold when the DFI exceeded 15% (37.5% for ICSI vs 8.8% for IVF).

The authors conclude that sperm DNA fragmentation measured 2 to 5 months before the assisted reproduction procedure was a prognostic indicator of the fertilization, pregnancy, and miscarriage rates and the pregnancy outcome.

EDITORIAL COMMENT:
DNA fragmentation as a measure of fertility has been steeped in controversy. There are numerous studies that have examined the relationship between DNA fragmentation and ART outcomes. The results have not been conclusive with regards to fertilization rates, embryo quality. Pregnancy rates do appear to be inversely related to DNA fragmentation rates. DNA fragmentation studies may be helpful in counseling the couple with unexplained infertility, failed IVF or recurrent miscarriage rates. The impact of DNA damage on offspring conceived by IVF and ICSI remains unclear. Could DNA fragmentation rates be related to the increased birth defects observed from IVF/ICSI ?

Benchaib M, Lornage J, Mazoyer C, Lejeune H, Salle B, François Guerin J

Fertility and Sterility 87: 93-100, 2007.

Written by Harris M. Nagler, MD, a Contributing Editor with UroToday.

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