Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada.
Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada.
Reprod Biomed Online. 2019 Jun;38(6):951-960. doi: 10.1016/j.rbmo.2018.12.029. Epub 2018 Dec 22.
Sperm DNA fragmentation (sDF) has emerged as a valuable tool for evaluating male fertility, yet the relationship between DNA fragmentation in the male gamete and idiopathic recurrent pregnancy loss (RPL) remains a topic of ongoing debate. Hence, a meta-analysis was conducted of 12 prospective and 2 retrospective studies involving 530 men with a history of RPL who underwent sDF testing compared with 639 fertile control participants. The main outcome measures were sDF measured by comet assay, TdT (terminal deoxynucleotidyl transferase)-mediated dUDP nick-end labelling (TUNEL), sperm chromatin dispersion (SCD) or sperm chromatin structure assay. Overall, couples with a history of idiopathic RPL demonstrated higher levels of sDF than fertile couples (average mean difference 11.98, P < 0.001). Subgroup analysis demonstrated a similar average mean difference between the RPL and control groups using SCD compared with TUNEL, while mean paternal age and mean sperm motility in the RPL groups tested by meta-regression demonstrated no significant effect on the mean differences in sDF (P > 0.10). These results support the diagnostic value of sDF over standard semen analysis, as well as a possible paternally derived genetic origin of unexplained RPL. Further prospective studies are required to further assess the predictive utility of sDF for assessing couples with unexplained RPL.
精子 DNA 碎片化（sDF）已成为评估男性生育力的有效工具，但精子中 DNA 碎片化与特发性复发性妊娠丢失（RPL）之间的关系仍然是一个持续争论的话题。因此，对 12 项前瞻性和 2 项回顾性研究进行了荟萃分析，这些研究涉及 530 名有 RPL 病史的男性，他们接受了 sDF 检测，与 639 名生育能力正常的对照参与者进行了比较。主要结局指标为彗星试验、末端脱氧核苷酸转移酶（TdT）介导的 dUDP 缺口末端标记（TUNEL）、精子染色质分散（SCD）或精子染色质结构试验测定的 sDF。总体而言，有特发性 RPL 病史的夫妇的 sDF 水平高于生育能力正常的夫妇（平均平均差异为 11.98，P<0.001）。亚组分析表明，与 TUNEL 相比，SCD 中 RPL 组和对照组之间的平均平均差异相似，而通过荟萃回归测试的 RPL 组中的平均父龄和平均精子活力对 sDF 的平均差异没有显著影响（P>0.10）。这些结果支持 sDF 对标准精液分析的诊断价值，以及不明原因 RPL 可能存在源自父系的遗传起源。需要进一步的前瞻性研究来进一步评估 sDF 对评估不明原因 RPL 夫妇的预测效用。
