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Hum. Reprod. Advance Access published online on August 18, 2006
Human Reproduction, doi:10.1093/humrep/del326
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received May 19, 2006
Revised June 30, 2006
Accepted July 14, 2006

Article

Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome

M. Bungum 1 *, P. Humaidan 2, A. Axmon 3, M. Spano 4, L. Bungum 2, J. Erenpreiss 5, and A. Giwercman 5

1 Fertility Clinic, Viborg Hospital (Skive), Skive, Denmark; Fertility Centre, Scanian Andrology Centre, Malmö University Hospital, Malmö
2 Fertility Clinic, Viborg Hospital (Skive), Skive, Denmark
3 Division of Occupational and Environmental Medicine and Psychiatric Epidemiology, Lund University, Lund, Sweden
4 Section of Toxicology and Biomedical Sciences, BIOTEC-MED, ENEA Casaccia Research Center, Rome, Italy
5 Fertility Centre, Scanian Andrology Centre, Malmö University Hospital, Malmö

* To whom correspondence should be addressed.
M. Bungum, E-mail: mona.bungum{at}med.lu.se


  Abstract

BACKGROUND: The sperm chromatin structure assay (SCSA) has been suggested as a predictor of fertility in vivo as well as in vitro. The available data however, have been based on limited numbers of treatments. We aimed to define the clinical role of SCSA in assisted reproduction. METHODS: A total of 998 cycles [387 intrauterine insemination (IUI), 388 IVF and 223 ICSI] from 637 couples were included. SCSA results were expressed as DNA fragmentation index (DFI) and high DNA stainable (HDS) cell fractions. Outcome parameters were biochemical pregnancy (BP), clinical pregnancy (CP) and delivery (D). RESULTS: For IUI, the odds ratios (ORs) for BP, CP and D were significantly lower for couples with DFI >30% as compared with those with DFI ≤30%. No statistical difference between the outcomes of ICSI versus IVF in the group with DFI ≤30% was seen. In the DFI >30% group, the results of ICSI were significantly better than those of IVF. CONCLUSIONS: DFI can be used as an independent predictor of fertility in couples undergoing IUI. As a result, we propose that all infertile men should be tested with SCSA as a supplement to the standard semen analysis. When DFI exceeds 30%, ICSI should be the method of choice.

Keywords: ICSI/IUI/IVF/SCSA/sperm DNA.
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