Sperm DNA decondensation assay and selection of assisted reproductive technology method

Abstract

Previously, sperm DNA integrity testing was reported to predict failure of sperm with assisted reproductive technology (ART) regardless of insemination method. Recent publications indicate that the sperm DNA integrity test, SCSA/SDFA, can identify reduced chances for success in some ART methods but not for others. The sperm DNA decondensation (SDD) test, a sperm function test, also previously has been shown to predict failure in all types of subsequent ART attempts. However, recent unpublished data suggest that ICSI can overcome sperm DNA function abnormalities identified by the SDD test. The goal of this retrospective review was to determine if SDD had predictive capability in current IUI and IVF insemination protocols. Retrospective chart review. Within a single fertility practice, all males electing to proceed with SDD testing were identified. ART success, defined as presence of fetal heart beat at 8–10 weeks gestation, was determined for first IUI or IVF attempt after SDD testing. An abnormal SDD score was defined as less than 80% of the control and normal was defined as greater than or equal to 80% of the control. There were no exclusions for female factor or WHO male factor etiology. SDD scores and first IUI or IVF attempt outcome data were available for 58 males. Forty-three males had normal SDD scores and had a 22% success rate with IUI (N = 23) and 35% with IVF (N = 20) attempts. Fifteen males had abnormal SDD scores with a 0% success rate with IUI (N = 6) and IVF (N = 9) attempts. The difference between the 28% success rate of SDD normal patients (N = 43, IUI/IVF combined) and 0% with SDD abnormal patients (N = 15, IUI/IVF combined) was statistically significant using Fischer's exact test (P=0.0325) (Odds Ratio >5). An additional 18 patients underwent IVF with ICSI where 81% (N = 16) of males with normal SDD scores had success and 100% (n = 2) with an abnormal SDD had success, although there was not sufficient statistical power to conclude that the groups were different. There was no significant difference for the average age and FSH levels of female partners between SDD normal and SDD abnormal groups. Overall clinical pregnancy rates for this fertility practice at the time of this study were: IUI, 15%; IVF and ICSI, 53%. Based upon preliminary retrospective data, the SDD may be able to identify those male patients with reduced chances of success with IUI and IVF who may benefit from earlier consideration of ICSI. Further definitive studies are needed.