Bungum M, Humaidan P, Axmon A, Spano M, Bungum L, Erenpreiss J, Giwercman A
Fertility Clinic, Viborg Hospital, Skive, Denmark.
Hum Reprod. 2007 Jan;22(1):174-9. doi: 10.1093/humrep/del326. Epub 2006 Aug 18.
The sperm chromatin structure assay (SCSA) has been suggested as a predictor of fertility in vivo as well as in vitro. The available data however, have been based on limited numbers of treatments. We aimed to define the clinical role of SCSA in assisted reproduction.
A total of 998 cycles [387 intrauterine insemination (IUI), 388 IVF and 223 ICSI] from 637 couples were included. SCSA results were expressed as DNA fragmentation index (DFI) and high DNA stainable (HDS) cell fractions. Outcome parameters were biochemical pregnancy (BP), clinical pregnancy (CP) and delivery (D).
For IUI, the odds ratios (ORs) for BP, CP and D were significantly lower for couples with DFI >30% as compared with those with DFI < or =30%. No statistical difference between the outcomes of ICSI versus IVF in the group with DFI < or =30% was seen. In the DFI >30% group, the results of ICSI were significantly better than those of IVF.
DFI can be used as an independent predictor of fertility in couples undergoing IUI. As a result, we propose that all infertile men should be tested with SCSA as a supplement to the standard semen analysis. When DFI exceeds 30%, ICSI should be the method of choice.
精子染色质结构分析（SCSA）已被认为是体内和体外生育能力的预测指标。然而，现有数据基于有限数量的治疗。我们旨在确定SCSA在辅助生殖中的临床作用。
纳入637对夫妇的998个周期[387个宫内人工授精（IUI）、388个体外受精（IVF）和223个卵胞浆内单精子注射（ICSI）]。SCSA结果以DNA碎片指数（DFI）和高DNA可染性（HDS）细胞分数表示。结局参数为生化妊娠（BP）、临床妊娠（CP）和分娩（D）。
对于IUI，DFI>30%的夫妇与DFI≤30%的夫妇相比，BP、CP和D的优势比（OR）显著更低。在DFI≤30%的组中，ICSI与IVF的结局之间未见统计学差异。在DFI>30%的组中，ICSI的结果显著优于IVF。
DFI可作为接受IUI夫妇生育能力的独立预测指标。因此，我们建议所有不育男性都应进行SCSA检测，作为标准精液分析的补充。当DFI超过30%时，ICSI应作为首选方法。
