Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark.
Reprod Biomed Online. 2024 Aug;49(2):103773. doi: 10.1016/j.rbmo.2023.103773. Epub 2023 Dec 18.
Are the prospective reproductive outcomes in couples experiencing recurrent pregnancy loss (RPL) related to the sperm DNA fragmentation index (DFI), as measured by sperm chromatin structure assay, sperm morphology and sperm concentration at referral?
This prospective cohort study included 95 couples seen between 1 April 2018 and 1 December 2019 at the tertiary Copenhagen RPL Unit, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Denmark. The couples had experienced three or more unexplained consecutive pregnancy losses or two late pregnancy losses (>12 weeks gestation). Follow-up was 12-31 months.
Eighty-one of 95 (85.3%) couples achieved pregnancy after referral. In the first pregnancy after referral, 46 (56.8%) couples achieved a live birth, and 35 (43.2%) couples experienced another pregnancy loss. There was no significant difference in baseline DFI between couples that experienced pregnancy loss [median 11.7, interquartile range (IQR) 9.1-17.3] and couples that achieved a live birth (median 12.5, IQR 9.3-16.5; P = 0.971). Improving sperm morphology increased the odds of a live birth after referral (adjusted OR 1.26, 95% CI 1.05-1.52; P = 0.014). DFI and sperm concentration were not associated with the outcome of the first pregnancy after referral. Overall, 35.9% of the men had DFI ≥15 at inclusion. Couples that failed to achieve pregnancy had a higher median DFI of 17.7 (IQR 7.7-27.2) compared with the rest of the cohort (median 12.0, IQR 9.3-16.5; P = 0.041).
At referral, sperm DFI, morphology and concentration cannot be used to identify RPL couples at risk of another pregnancy loss. Increased baseline DFI was associated with difficulty achieving another pregnancy, and improving sperm morphology was associated with increased odds of a live birth.
通过精子染色质结构分析（SCSA）测量的精子 DNA 碎片指数（DFI），与在转诊时的精子形态和精子浓度，与经历复发性妊娠丢失（RPL）的夫妇的预期生殖结局相关吗？
本前瞻性队列研究纳入了 2018 年 4 月 1 日至 2019 年 12 月 1 日在丹麦哥本哈根 RPL 单位、哥本哈根大学医院、里格夏医院和 Hvidovre 医院就诊的 95 对夫妇。这些夫妇经历了三次或更多次不明原因的连续妊娠丢失或两次晚期妊娠丢失（>12 周妊娠）。随访时间为 12-31 个月。
95 对夫妇中有 81 对（85.3%）在转诊后成功妊娠。在转诊后的第一次妊娠中，46 对（56.8%）夫妇成功分娩，35 对（43.2%）夫妇再次妊娠丢失。经历妊娠丢失的夫妇的基线 DFI 与成功分娩的夫妇无显著差异[中位数 11.7，四分位距（IQR）9.1-17.3]和[中位数 12.5，IQR 9.3-16.5；P=0.971]。改善精子形态可增加转诊后活产的几率（调整后的 OR 1.26，95%CI 1.05-1.52；P=0.014）。DFI 和精子浓度与转诊后的第一次妊娠结局无关。总的来说，35.9%的男性在纳入时的 DFI≥15。未能妊娠的夫妇的中位 DFI 为 17.7（IQR 7.7-27.2），高于队列的其余部分（中位值 12.0，IQR 9.3-16.5；P=0.041）。
在转诊时，精子 DFI、形态和浓度不能用于识别有再次妊娠丢失风险的 RPL 夫妇。较高的基线 DFI 与再次妊娠困难相关，而改善精子形态与活产几率增加相关。
