Sperm DNA Fragmentation Index, Semen Quality, and Assisted Reproductive Technology Outcomes: A Systematic Review and Meta-analysis of Observational Studies.
Tingyu Bao, Shuting Zhang, Jianping Ou
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In 30 seconds
This systematic review and meta-analysis of 87 observational studies assessed associations between sperm DNA fragmentation index (DFI), semen parameters, and assisted reproductive technology (ART) outcomes. Compared with high DFI, low DFI was associated with higher clinical pregnancy, live birth, and embryo implantation rates, and lower miscarriage risk. The strongest reported association was for implantation (RR = 1.198, 95% CI:1.085-1.323). After adjustment for publication bias, associations with clinical pregnancy and live birth were no longer significant, whereas those with implantation and miscarriage remained. The findings are population-level associations, not evidence that DFI-guided care improves outcomes.
Key findings
- Low DFI was associated with higher clinical pregnancy rate (RR = 1.121, 95% CI:1.068-1.178), but this association lost significance after publication bias adjustment.
- Low DFI was associated with higher live birth rate (RR = 1.136, 95% CI:1.063-1.215); this association also lost significance after publication bias adjustment.
- Low DFI was associated with higher embryo implantation rate (RR = 1.198, 95% CI:1.085-1.323), and the association remained robust after publication bias adjustment.
- Low DFI was associated with lower miscarriage risk (RR = 0.731, 95% CI:0.652-0.820); this association remained robust after publication bias adjustment.
Why it matters
The findings suggest that sperm DNA integrity may provide information relevant to ART outcomes beyond routine semen parameters. However, the attenuation of some associations after publication bias adjustment and the observational evidence base mean that DFI should not be interpreted as a proven determinant of treatment success. The results help frame DFI as a potentially informative measure whose clinical value requires further clarification.
What to keep in mind
The evidence comes from observational studies, so associations do not establish causation. Publication bias adjustment removed significance for clinical pregnancy and live birth associations.