THE CORRELATION BETWEEN DNA FRAGMENTATION INDEX (DFI), SPERM PARAMETERS, EUPLOIDY AND PREGNANCY OUTCOMES AFTER ICSI

Introduction: DNA fragmentation index (DFI) is a diagnostic assessment that measures the percentage of denatured sperm (DNA damage) in a semen sample. A low DFI score (<15%) is thought to be associated with better success in natural conception and assisted reproductive technology. In contrast, a borderline DFI score (> 15% to < 30%) indicates good to fair fertility potential, and a high DFI score (≥ 30%) has been associated with poor fertility. Objective: This study investigated the relationship between sperm parameters including DFI scores, and their impact on embryo development, euploidy status and pregnancy rates. Design: A retrospective cohort study at a university-affiliated private clinic. Materials and Methods: Patients (n=98) were stratified into one of three groups based on DFI score: DFI <15% (n=57); DFI > 15% to < 30% (n=31); and DFI ≥ 30% (n=10) for comparison. Sperm was processed for ICSI using a conventional swim-up method. Descriptive statistics were calculated as mean ± standard deviation. A one-way ANOVA comparing concentration, motility and morphology between each cohort was calculated. To investigate embryo euploidy and pregnancy rates, borderline and high DFI scores were combined and compared to low DFI scores using a chi-square analysis. A p-value < 0.05 was considered statistically significant. Results: Age of female partner, dose of FSH and E2 levels were similar amongst the three groups. Low DFI samples had significantly higher motility (p=0.037), concentration (p<0.001), morphology (p=0.007) and post swim-up motility (p=0.026) when compared to samples with a high DFI. No difference was seen in overall pregnancy rates. Subsequent analysis between embryo euploidy rates between low DFI (30.8%, n=9) and borderline to high DFI (34.0 %, n = 8) showed no difference (p = 0.830). Conclusions: Sperm parameters associated with a low DFI score had no impact on embryo euploidy and pregnancy rates. We propose that the swim-up preparation and selection of sperm by the embryologist for ICSI mitigates the effects of high DFI. Further investigation and a sufficiently powered sample size is required to confirm results. Support: In-kind contribution from ONE Fertility.