ICSI in Cases of Sperm DNA Damage: Beneficial Effect of Oral Antioxidant Treatment

Abstract

referral clinic. Patient(s): We collected 303 semen samples from patients undergoing IVF with or without ICSI. Intervention(s): Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) assay, measurement of fertilization rates, good embryo rates, and pregnancy rates for the IVF/ICSI program. Main Outcome Measure(s): The percentage of sperm with DNA fragmentation, correlated with semen analysis parameters and IVF/ICSI outcomes. Result(s): Sperm DNA fragmentation rates were significantly higher in patients with abnormal sperm parameters than in those with normal sperm parameters. When sperm DNA fragmentation was 10%, fertilization rates were affected. Sperm DNA fragmentation rates were negatively correlated with sperm velocity parameters but did not affect pregnancy outcomes. Conclusion(s): The results indicated that sperm DNA fragmentation affects fertilization rates and sperm motility but might not affect pregnancy rates. Editorial Comment: Since ICSI allows a single immotile sperm, even a dead one, to fertilize an ovum, an assay for sperm DNA integrity would prove useful in counseling couples undergoing the procedure. These investigators assessed sperm DNA integrity as measured by the TUNEL assay, and correlated outcomes in 303 women undergoing in vitro fertilization (86 with ICSI.) DNA fragmentation correlated poorly with bulk seminal parameters, including morphology, supporting the concept that the look of a sperm and its DNA are different things, and drawing into question the ability of a technician to select a good sperm for ICSI based on appearance alone. DNA fragmentation did affect fertilization rates and embryo quality, suggesting a possible prognostic value for sperm TUNEL assay.