Hum. Reprod. Advance Access originally published online on March 16, 2006
Human Reproduction 2006 21(6):1576-1582; doi:10.1093/humrep/del019
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The sperm chromatin structure assay as a diagnostic tool in the human fertility clinic
1 Department of Large Animal Sciences, Section for Veterinary Reproduction & Obstetrics, The Royal Veterinary & Agricultural University, Frederiksberg C, 2 The Fertility Clinic and The Scientific Unit, Brædstrup Hospital, Brædstrup, and 3 Department of Large Animal Sciences, Section for Population Biology, The Royal Veterinary and Agricultural University, Frederiksberg C, Denmark
4 To whom correspondence should be addressed at: Department of Large Animal Sciences, Section for Veterinary Reproduction and Obstetrics, The Royal Veterinary and Agricultural University, Dyrlaegevej 68, 1870 Frederiksberg C, Denmark. E-mail: gbh{at}kvl.dk
BACKGROUND: Sperm DNA integrity has been shown to be necessary for achieving and sustaining embryo development. The objective was to evaluate the sperm chromatin structure assay (SCSA) as a diagnostic tool in clinical practice for intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments. METHODS: A total of 385 semen samples from 234 couples were frozen for SCSA, and smears were prepared for morphology: 48 IUI, 139 IVF and 47 ICSI. The main SCSA variables were DNA fragmentation index (DFI), standard deviation of DFI (SD-DFI) and high DNA stainability (HDS), and the reproductive outcomes were biochemical pregnancy (BP), clinical pregnancy (CP) and implantation ratio (IR). RESULTS: The results showed no significant difference in the fertility variables BP, CP and IR when <27% DFI was used between the IVF and ICSI groups. A low number of patients received IUI with low success rate, and statistical analysis was therefore not performed. Ongoing pregnancy was achieved for both IVF and ICSI couples with DFI levels >27%, and six couples in ICSI treatment achieved CP full-term. DFI >27% had a high prognostic power for predicting no CP for IVF patients, with a specificity of 97%. Couples diagnosed with male infertility had a significantly higher level of DFI compared to couples with idiopathic fertility. Sperm head morphology showed low but significant correlations with the SCSA variables. CONCLUSION: SCSA is a useful tool in andrological diagnosis and contributes with a prognosis for the fertility outcome of conventional IVF. Although full-term pregnancy can be achieved with assisted reproductive techniques with a DFI >27%, the probability of a successful pregnancy may be reduced.
Key words: male infertility/morphology/pregnancy/sperm DNA fragmentation/spermatozoa
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