Do sperm DNA integrity tests predict pregnancy with in vitro fertilization?
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OBJECTIVE: To evaluate the predictive value of sperm DNA integrity tests for pregnancy from in vitro fertilization treatment. DESIGN: Systematic review and meta-analysis. SETTING: Studies from infertility centers. PATIENT(S): Infertile couples undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment. INTERVENTION(S): Sperm DNA integrity tests before IVF and ICSI cycles. MAIN OUTCOME MEASURE(S): Diagnostic test properties for sperm DNA integrity tests with reference to pregnancy after IVF or ICSI treatment. RESULT(S): Among 22 relevant studies, 2 x 2 tables were constructed from 13 studies involving 18 estimates of the diagnostic test properties of sperm DNA integrity tests in 2162 cycles of treatment. The sum of sensitivity and specificity ranged from 0.83 to 1.59. In six of 18 estimates abnormal DNA integrity was associated with a higher than expected pregnancy rate. The summary diagnostic odds ratio was 1.44 (95% CI, 1.03, 2.03), but the summary likelihood ratios (LR) were not predictive of pregnancy outcome (LR+ = 1.23; 95% CI, 0.98, 1.54; LR- = 0.81; 95% CI, 0.67, 0.98). Neither sperm chromatin structure assay nor terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay tests were more predictive of pregnancy outcome after IVF/ICSI, and DNA integrity testing was not more predictive for IVF than ICSI. CONCLUSION(S): The small but statistically significant association between sperm DNA integrity test results and pregnancy in IVF and ICSI cycles is not strong enough to provide a clinical indication for routine use of these tests in infertility evaluation of men. It is possible that yet to be determined subgroups of infertile couples may benefit from sperm DNA integrity testing.
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