Abstract
Several studies have explored the relationship among traditional semen parameters, sperm DNA fragmentation (SDF), and unexplained recurrent miscarriage (RM); however, the findings remain controversial. Hence, we conducted a meta-analysis to explore the relationship among traditional semen parameters, SDF, and unexplained RM. Multiple databases, including PubMed, Google Scholar, MEDLINE, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI), were searched to identify relevant publications. From the eligible publications, data were extracted independently by two researchers. A total of 280 publications were identified using the search strategy. According to the inclusion/exclusion criteria, 19 publications were eligible. A total of 1182 couples with unexplained RM and 1231 couples without RM were included in this meta-analysis to assess the relationship among traditional semen parameters, SDF, and unexplained RM. Our results showed that couples with unexplained RM had significantly increased levels of SDF and significantly decreased levels of total motility and progressive motility compared with couples without RM, although significant differences were not observed in the semen volume, sperm concentration, and total sperm count between couples with and without RM. The SDF assay may be considered for inclusion in evaluations of couples with unexplained RM.
Highlights
A uniform definition of recurrent miscarriage (RM) has not been established
The search was limited to human studies published in English and included using the following terms: “recurrent pregnancy loss”, “repeated pregnancy loss”, “recurrent abortions”, “recurrent spontaneous abortion”, “recurrent miscarriage”, “sperm DNA fragmentation”, “sperm DNA integrity”, “sperm DNA damage”, “Sperm DNA fragmentation (SDF)”, “DFI”, “traditional semen parameters”, and “conventional semen parameters”
Some studies have reported that male partners of couples with unexplained RM had significantly decreased levels of semen volume [26] and progressive motility [19, 27, 31, 34, 35] compared with couples without RM, but significant differences were not observed in sperm concentration [19,20,21, 23,24,25,26,27,28,29,30,31, 33, 35, 36, 38], total sperm count [23, 24, 26, 27, 29, 30] and total motility [20, 21, 24, 36] between the two groups
Summary
A uniform definition of recurrent miscarriage (RM) has not been established. The American Society for Reproductive Medicine (ASRM) defines RM as two or more consecutive miscarriages [1], while the Royal College of Obstetricians and Gynecologists (RCOG), the Chinese Society of Obstetrics and Gynecology, and the European Society of Human Reproduction and Embryology (ESHRE) guidelines define RM as three or more consecutive miscarriages [2,3,4]. Sperm DNA fragmentation (SDF) is used to assess the integrity of sperm chromatin and has been increasingly recognized as crucial because of its diagnostic potential in terms of male fertility and pregnancy outcomes. A certain degree of sperm DNA damage can be repaired by the oocyte; when the damage exceeds the repair capacity of the oocyte, adverse pregnancy outcomes may occur [11]. Many clinical studies have investigated the relationship between SDF and reproductive outcomes, and several studies have suggested that SDF is associated with poor fertilization, suboptimal embryo quality, and lower pregnancy rates [12,13,14,15]. Other studies have indicated that SDF is not associated with the fertilization rate or pregnancy outcome [17, 18]. The implications of SDF on fertilization rate and pregnancy outcome remain controversial
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