Effect of Sperm Dna Fragmentation Index on Clinical Outcomes of Intra-Uterine Insemination Patients

Abstract

Objective: To study the effect of sperm chromatin condensation (DNA fragmentation index (DFI)) using aniline blue-eosin (AB-E) staining on pregnancy outcomes in patients facing unexplained infertility undergoing intra- uterine insemination (IUI). Our initial hypothesis states that if DNA fragmentation is high then chances of pregnancy are low/NIL hence these patients should be recommended with advanced ART procedures like IVF and ICSI. Design: Prospective study Setting: Tertiary care infertility centre Method: A total of 185 patients with age less than 40 years, non-smokers and without history of any pathogenic infection in the past 2months facing unexplained infertility i.e., males with normal semen analysis reports and females with normal ovulation and hysterosalpingography (HSG) reports were selected for the study. Patients were undergoing their first or second IUI treatment cycle between the period of June 2016 to December 2016. DNA fragmentation index (DFI) using aniline blue- eosin staining method was studied in semen samples provided on the day of IUI procedure. The patients were separated into 3 groups: low DFI (DFI<= 10%), medium DFI (DFI=11 % - 20%), and high DFI (DFI >= 21%) and clinical pregnancy outcomes of IUI were recorded. Statistical analysis was performed using Pearson correlation co-efficient, ANOVA and Shapiro Wilk Test on the above groups. Main Outcome Measures: DNA fragmentation index (DFI) (%), Clinical pregnancy rate (%) Result: The overall clinical pregnancy rate for the selected patient pool was 21.08% with an average DFI of 8.84% in the pregnant female group and 14.65% in the non-pregnant female group. Sperm DFI % and clinical outcomes in IUI treated patients were statistically significant and negatively correlated with correlation coefficient (r) of -0.1, -0.3 and -0.3 in low DFI%, medium DFI and high DFI% groups respectively. Conclusion: Our study demonstrated that DFI (%) and clinical pregnancy rate (%) are significantly and negatively correlated in patients with normal semen parameters undergoing IUI. The higher the DFI% the chances of clinical pregnancy become very low, therefore, these patients should not be recommended IUI but with advanced ART procedures like IVF and ICSI.