Abstract
Female factors are very important in determining the success of in vitro fertilization (IVF). However, many reports have shown that male factors also affect the success or failure of IVF. Therefore, the sperm evaluation is important, semen examination criteria based on conventional methods alone is not a primary factor of consideration for determining IVF embryonic potential, pregnancy rates, and miscarriage rates after transplantation. We performed and analyzed the sperm DNA fragmentation index (DFI) and general semen test based on the WHO criteria and compared the two using semen factors. This study was conducted from June 2020 to December 2020. A total of 134 male patients with the main complaint of infertility who requested semen testing were included. We evaluate sperm motility using an automatic sperm analyzer based on the WHO criteria and sperm morphology via the Kruger test (general semen tests). DFI and general semen test were conducted in accordance with the WHO criteria, and correlations between the two tests were investigated. The WHO criteria were set as the cutoff value for each of the following factors: fluid volume, concentration, motility, and normal morphology, and compared with the DFI results. The mean age of the 134 patients at the time of the sperm tests was 38.8±6.0 years (range=26-52 years). The subjects had a mean DFI of 15.6±11.5% and the DFI increased with age (r=0.2319, p<0.01). In contrast, the concentration, motility, and normal morphology decreased as the DFI increased (concentration; r=-0.1992, p<0.05; motility; r=-0.2672, p<0.01; normal morphology; r=-0.2881, p<0.001). Patients who satisfied the WHO criteria in terms of sperm concentration, motility, and normal morphology had a significantly lower DFI than the group that did not satisfy the criteria (concentration p<0.05; motility p<0.01; normal morphology p<0.01). Therefore, evaluation with a general semen test based on the WHO criteria should be regarded as a qualitative evaluation of all factors other than fluid volume. Male infertility due to DFI should be suspected when in vitro fertilization results are poor despite normal semen findings based on the WHO criteria. The results of this study suggest that the DFI test may be an important evaluation in follow-up semen analyses.
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