On-going clinical pregnancies in couples with a sperm DNA fragmentation index (DFI) > 30%

Abstract

To determine what percentage of couples where the male partner has fair to poor fertility potential according to DNA fragmentation studies achieve a healthy pregnancy following in vitro fertilization (IVF) protocols. Case report. Clinical studies reported by SCSA Diagnostics (Brookings, SD) suggest that males with a DNA fragmentation index above 30 % are in a group of sub-fertile men that demonstrate a longer period to establish a pregnancy, more required IVF/ intracytoplasmic sperm injection cycles, and are at increased risk of spontaneous abortion or no pregnancy (fair to poor fertility potential). SCSA Diagnostics suggests that men with a DFI ≤ 15% have excellent fertility potential and men between 15 and 29.9% have good to fair fertility potential. We performed a preliminary study to determine the clinical outcome of couples undergoing IVF where the male had a DFI ≥ 30 %. DNA fragmentation studies were performed by SCSA Diagnostics (Brookings, SD). Fifty-eight couples were enrolled in the study. Female inclusion criteria are women < 37, those with regular ovulatory cycles, and normal ovarian function (< 10 mIU/ml FSH day 3 and < 80 pg/ml E2). 31% (18 / 58) of men exhibited excellent fertility potential (mean = 10.1 %, range: 4.8 − 14.4 %). 48.3 % (28 / 58) of men had good to fair fertility potential (mean = 21.4 %, range: 15 − 29.2 %), whilst 20.7% (12 / 58) of studied men had fair to poor fertility potential (mean = 44.6 %, range: 31.4 − 58.2 %). 25 % (3 / 12) of couples where the male partner has fair to poor fertility potential have successful ongoing pregnancies. Each pregnancy is ≥ 10 weeks gestation. One couple has undergone 3 unsuccessful IVF cycles and 3 unsuccessful frozen embryo transfers (FET). The female is 35 and the male partner has normal conventional semen parameters. His DFI is 58.2%. They have a healthy singleton pregnancy. The second couple has one previous unsuccessful IVF cycle, her age is 35 and the male partner has abnormal semen parameters. His DFI is 31 %. The couple has a healthy ongoing twin pregnancy. The third couple has 3 previous unsuccessful intrauterine inseminations. Her age is 31 and he has abnormal semen parameters. His DFI is 32%. The couple has an ongoing twin pregnancy. While a DNA fragmentation index ≥ 30% may play a significant role in unexplained male infertility, it does not preclude the chance of a couple achieving a healthy pregnancy.