High sperm deoxyribonucleic acid fragmentation index is associated with an increased risk of preeclampsia following assisted reproduction treatment

Abstract

To study the association between sperm DNA fragmentation index (DFI) and the odds of preeclampsia and other adverse perinatal outcomes after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment. A prospective cohort study including infertile couples undergoing conventional IVF or ICSI treatment and their children. Data regarding preeclampsia and perinatal outcomes were derived from the Swedish National Birth Register. 1594 infertile couples undergoing IVF or ICSI treatment and their 1660 children conceived by assisted reproduction. Sperm DNA fragmentation index measured by Sperm Chromatin Structure Assay. The primary outcome was preeclampsia. Secondary outcomes were preterm birth, low birth weight, low Apgar score, and small for gestational age. With DFI < 20% as a reference, the OR for preeclampsia was statistically significantly increased in the group with DFI ≥ 20% when IVF was used as fertilization method (OR 2.2; 95% CI 1.1 to 4.4; p = 0.02). Already at DFI levels ≥ 10%, in IVF pregnancies, preeclampsia odds were increased in a dose-response manner, from a prevalence of 3.1% in the reference group to more than 10% among those with DFI of 30% or higher. The DFI was not associated with preeclampsia odds in the ICSI group. In the entire cohort, DFI ≥ 20% was associated with an increased OR of preterm birth (OR 1.4; 95% CI 1.0 to 2.0; p = 0.03). High DNA fragmentation index was associated with increased odds of preterm birth and, in IVF pregnancies, also increased odds of preeclampsia.