Affiliation:
1. Department of Urology Glickman Urological and Kidney Institute Cleveland Clinic Foundation Cleveland Ohio USA
2. Department of Molecular Cell and Cancer Biology Umass Chan Medical School Worcester Massachusetts USA
3. Department of Obstetrics and Gynecology Galilee Medical Center Nahariya Israel
4. Azrieli Faculty of Medicine Bar Ilan University Safed Israel
5. Department of Clinical and Experimental Medicine University of Catania Catania Italy
Abstract
AbstractObjectiveElevated 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.Materials and methodsThis 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.ResultsOf 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.ConclusionsThe 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.