Kaiyal Raneen Sawaid, Karna Keshab Kumar, Kuroda Shinnosuke, Sgayer Inshirah, Shlush Ekaterina, Vij Sarah C, Lundy Scott D, Cannarella Rossella
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Molecular Cell and Cancer Biology, Umass Chan Medical School, Worcester, Massachusetts, USA.
Andrology. 2025 May;13(4):718-730. doi: 10.1111/andr.13725. Epub 2024 Aug 12.
Elevated sperm DNA fragmentation has potential implications for semen quality and fertility. The commonly used sperm chromatin dispersion test offers an indirect estimation but has limitations in terms of bias and variability. This study aimed to assess the reliability of the sperm chromatin dispersion assay for predicting assisted reproductive technology outcomes.
This systematic review included studies published until December 2023 that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Scopus, and Google Scholar databases were searched. Various assisted reproductive technology outcomes in patients with high (≥ 30%) versus low (< 30%) sperm DNA fragmentation were compared using a sperm chromatin dispersion assay and including a sub-analysis of intracytoplasmic sperm injection versus in vitro fertilization. A comprehensive meta-analysis software facilitated quantitative analysis with statistical comparisons between cases and controls. Interstudy heterogeneity was assessed, and sensitivity and publication bias tests were performed.
Of the 199 abstracts assessed, 64 full-text articles were screened, and 44 articles were qualitatively synthesized. Fourteen articles representing 5346 participants were quantitatively analyzed. Using the sperm chromatin dispersion assay, elevated sperm DNA fragmentation was associated with lower fertilization and embryo cleavage rates. Notably, high sperm DNA fragmentation levels did not affect the clinical pregnancy, implantation, miscarriage, or live birth outcomes. Sub-analysis revealed lower fertilization, embryo cleavage, clinical pregnancy, live birth rates, and higher miscarriage rates in the intracytoplasmic sperm injection subgroup only.
The sperm chromatin dispersion assay did not show significant differences in pregnancy or live birth rates between the high- and low-sperm DNA fragmentation groups. Noteworthy, high sperm DNA fragmentation was associated with worse assisted reproductive technology outcomes in the intracytoplasmic sperm injection group. Given the current quality of the evidence, affected by the experimental design and the absence of correction for female factors of infertility, clinicians should be wary of the assay's limited predictive power for pregnancy and live birth outcomes.
精子DNA碎片化程度升高对精液质量和生育能力具有潜在影响。常用的精子染色质扩散试验提供了一种间接估计方法，但在偏差和变异性方面存在局限性。本研究旨在评估精子染色质扩散试验预测辅助生殖技术结局的可靠性。
本系统评价纳入了截至2023年12月发表的遵循系统评价和Meta分析优先报告项目指南的研究。检索了PubMed/MEDLINE、Scopus和谷歌学术数据库。使用精子染色质扩散试验比较了精子DNA碎片化程度高（≥30%）与低（<30%）的患者的各种辅助生殖技术结局，并对卵胞浆内单精子注射与体外受精进行了亚分析。一个综合的Meta分析软件有助于进行定量分析，并对病例和对照进行统计比较。评估了研究间的异质性，并进行了敏感性和发表偏倚测试。
在评估的199篇摘要中，筛选了64篇全文文章，并对44篇文章进行了定性综合分析。对代表5346名参与者的14篇文章进行了定量分析。使用精子染色质扩散试验，精子DNA碎片化程度升高与较低的受精率和胚胎分裂率相关。值得注意的是，高精子DNA碎片化水平并未影响临床妊娠、着床、流产或活产结局。亚分析显示，仅在卵胞浆内单精子注射亚组中受精率、胚胎分裂率、临床妊娠率、活产率较低，流产率较高。
精子染色质扩散试验在精子DNA碎片化程度高和低的组之间的妊娠率或活产率方面未显示出显著差异。值得注意的是，在卵胞浆内单精子注射组中，高精子DNA碎片化与较差的辅助生殖技术结局相关。鉴于目前证据的质量受到实验设计和未对女性不孕因素进行校正的影响，临床医生应警惕该试验对妊娠和活产结局的预测能力有限。
