The Effect of Sperm DNA Fragmentation Index on the Outcome of Intrauterine Insemination and Intracytoplasmic Sperm Injection

CONTEXT: Elevated sperm DNA fragmentation index (DFI) is found to affect normal embryonic development, implantation and fetal development after intrauterine insemination (IUI), in vitro fertilization and intracytoplasmic sperm injection (ICSI). Estimation of DFI by terminal deoxynucleotidyl transferase-mediated fluorescent deoxy uridine nucleotide nick end labeling (TUNEL) assay was found to have a high predictive value for pregnancy after fertility treatments. AIM: This study aims to find the effect of increased sperm DNA fragmentation by TUNEL assay on reproductive outcome after IUI and ICSI. PRIMARY OBJECTIVE: To find the association of DFI and pregnancy rate in IUI and ICSI. SECONDARY OBJECTIVES: To find the association of DFI with fertilization and implantation in ICSI. To find the association of DFI with miscarriage rate. SETTINGS AND DESIGN: A prospective observational study performed at a tertiary care university teaching hospital. SUBJECTS AND METHODS: 105 male partners of infertile couple planned for IUI and ICSI underwent estimation of sperm-DFI by TUNEL assay. The treatment outcomes were compared between the DFI-positive (≥20%) and DFI-negative (<20%) groups. STATISTICAL ANALYSIS USED: Statistical analysis was performed by SPSS version 17, Software. P < 0.05 was considered statistically significant. RESULTS: The men with abnormal semen analysis were significantly higher in the DFI-positive group (77.15% vs. 22.85%). There was no significant difference in the pregnancy rate in IUI cycles (17.6% vs. 11.8%); but in the ICSI, the pregnancy rate was significantly reduced in the DFI-positive group (16.7% vs. 47.4%). CONCLUSIONS: Elevated DFI significantly affects the pregnancy rate in ICSI cycles.