Centre for Reproductive Medicine - Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Clinical Trial Centre - Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2020 Jan;244:8-15. doi: 10.1016/j.ejogrb.2019.10.005. Epub 2019 Oct 22.
There is a growing body of literature that recognizes the importance of sperm DNA fragmentation as a candidate test for the assessment of sperm function and thus male reproductive potential. Research on the subject has mostly been focused on couples undergoing IVF/ICSI treatment whilst much uncertainty still exists about the relationship between sperm DNA fragmentation and IUI. This study systematically reviews the literature, aiming to define the value of sperm DNA fragmentation measurement in predicting clinical pregnancy outcome in couples undergoing intra-uterine insemination From inception until March 2018, the relevant databases were searched for studies investigating the relationship between sperm DNA fragmentation as measured by SCSA, TUNEL, SCD or Comet assay and pregnancy outcome after IUI. The Quality in Prognosis Studies (QUIPS) tool was utilized for quality assessment. This review is reported according to the 2009 PRISMA statement. The literature search resulted in 433 studies of which we finally retained nine studies for the qualitative analysis and four studies for the meta-analysis, accounting for 940 IUI cycles. In summary, the observed effect of low sperm DNA fragmentation on clinical pregnancy after IUI as analyzed with the random effects model reveals a relative risk of 3.15 (95% CI: 1.46-6.79; I2 = 13.1%) and pooled sensitivity and specificity of respectively 94% (95% CI: 0.88; 0.97) and 19% (95% CI: 0.14; 0.26). Taken together, the included studies show a limited capacity of sperm DNA fragmentation in discriminating between couples who will benefit from the test, namely in either predicting IUI outcome or in advising for or against IUI as first choice of treatment instead of advancing to more invasive medically assisted reproduction. This review has thrown up many questions in need of further investigation. As such, future studies might explore issues such as determining relevant cut-off values for prediction of spontaneous pregnancy and pregnancy after IUI as well as the assessment of the stability of the test over time and before and after density gradient centrifugation.
越来越多的文献认识到精子 DNA 碎片化作为评估精子功能和男性生殖潜能的候选检测方法的重要性。该主题的研究主要集中在接受 IVF/ICSI 治疗的夫妇，而精子 DNA 碎片化与 IUI 之间的关系仍然存在很大的不确定性。本研究系统地综述了文献，旨在确定精子 DNA 碎片化测量在预测接受宫腔内人工授精的夫妇临床妊娠结局中的价值。
从成立到 2018 年 3 月，检索了相关数据库，以调查通过 SCSA、TUNEL、SCD 或彗星试验测量的精子 DNA 碎片化与 IUI 后妊娠结局之间的关系。使用预后研究质量评估工具（QUIPS）进行质量评估。本综述根据 2009 年 PRISMA 声明进行报告。文献检索产生了 433 项研究，其中我们最终对 9 项研究进行了定性分析，对 4 项研究进行了荟萃分析，共纳入 940 个 IUI 周期。
总之，使用随机效应模型分析精子 DNA 碎片化对 IUI 后临床妊娠的影响，观察到低精子 DNA 碎片化的相对风险为 3.15（95%CI：1.46-6.79；I²=13.1%），汇总的敏感度和特异度分别为 94%（95%CI：0.88；0.97）和 19%（95%CI：0.14；0.26）。
综上所述，纳入的研究表明精子 DNA 碎片化在区分将从该检测中受益的夫妇方面能力有限，即无论是预测 IUI 结局，还是建议进行或不进行 IUI 作为首选治疗，而不是推进到更具侵入性的医学辅助生殖。本综述提出了许多需要进一步研究的问题。因此，未来的研究可能会探索确定预测自然妊娠和 IUI 后妊娠的相关截断值、评估该测试在时间上以及在密度梯度离心前后的稳定性等问题。
