Prospective reproductive outcomes according to sperm parameters, including DNA fragmentation, in recurrent pregnancy loss

Abstract

Research questionAre the prospective reproductive outcomes in RPL couples related to sperm DNA fragmentation index (DFI) measured by SCSA, morphology and concentration at referral? DesignA prospective cohort study including 95 couples seen between 01/04/2018 and 01/12/2019 at the tertiary Copenhagen RPL Unit, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Denmark. The couples had experienced three or more unexplained consecutive pregnancy losses (PLs) or two late PLs (>12 weeks gestation) Follow-up was 12-31 months. ResultsEighty-one of 95 couples (85.3%) achieved a pregnancy after referral. In the first pregnancy, 46 couples (56.8%) achieved a live birth, and 35 (43.2%) experienced another PL. There was no significant difference in baseline DFI between couples who experienced a pregnancy loss (median 11.7, IQR 9.1–17.3) and couples who had a live birth (median 12.5, IQR 9.1–16.5, p=0.971). Improving sperm morphology increased the odds of live birth after referral (aOR=1.26, 95%CI 1.05-1.52, p=0.014). DFI and sperm concentration were not associated with the outcome of the first pregnancy. Overall, 35.9 % of the men had DFI>15 at inclusion. Couples who failed to achieve pregnancy had a higher median DFI of 17.7 (IQR 7.7-27.2) compared with the rest of the cohort (median 12.0, IQR 9.3-16.5, p=0.041). ConclusionsAt referral, sperm DFI (SCSA assay), morphology and concentration cannot be used to identify RPL couples at risk of another PL. Increased baseline DFI was associated with difficulty to achieve another pregnancy and improving sperm morphology was associated with increased odds of live birth.