What DNA integrity means for fertility treatment

DNA integrity affects the results of fertility treatment for around 50% of childless couples. The different types of fertility treatments are not affected to the same extent. The reason for this is that the fragile sperm DNA is damaged when the sperm produces energy to swim to and fertilise the egg.

DNA integrity and DFI

The SDI-test examines the sperm DNA integrity. When the integrity is good, the sperm DNA is robust and is unlikely to become damaged. When the integrity is suboptimal or poor the sperm DNA is fragile and it may therefor become damaged before the egg is fertilised. The result of the SDI-test is the DFI value (DFI stands for DNA Fragility Index). DFI varies from 0 to 100: A low DFI means that the DNA is robust. A high DFI means that the DNA is fragile.

Robust DNA:
DFI is below 15. The integrity of the sperm DNA is good.

Moderate DNA fragility:
DFI is between 15 and 25. The integrity of the sperm DNA is suboptimal.

High DNA fragility:
DFI is above 25. The integrity of the sperm DNA is poor.

Half of the involuntarily childless men have robust DNA.
A quarter has moderate DNA fragility.
The remaining quarter have high DNA fragility.

Artificial insemination (IUI)

Artificial Insemination IUI
The graph shows the number of couples that have managed to become pregnant after their first artificial insemination (IUI), where the sperm DNA quality had low, moderate or high DFI (DNA Fragility Index).
To take into account any miscarriages, the pregnancy numbers are based on positive scans in the 12th week of pregnancy.
The graph shows the results of previous studies with artificial insemination. The results of a large study which was begun in 2011 are expected to be published in 2016.

With artificial insemination, sperm are introduced into the uterus and have to swim the long way to the fallopian tube, find the egg and fertilise it. The chances of pregnancy are significantly reduced for couples, where the man has moderate or high DNA fragility.

Test tube fertilisation (IVF)

Test Tube Fertilisation IVF
The graph shows the number of couples that have managed to become pregnant after their first test tube fertilisation (IVF), where the sperm DNA quality had low, moderate or high DFI (DNA Fragility Index). 210 couples took part in the study.
To take into account any miscarriages, the pregnancy numbers are based on positive scans in the 12th week of pregnancy.
The data is from Sims IVF (Dublin, The Republic of Ireland) and Fertility Center Hamburg (Germany), and was published at a European Fertility Conference (ESHRE) in 2013. The two clinics, however, did not carry out test tube fertilisation in cases of high DNA fragility levels. This column is based on a previous study.

The journey to the egg is shorter when sperm are placed together with the egg during test tube fertilisation. The chances of pregnancy are greater than with artificial insemination. The sperm, however, still needs to swim and fertilise the egg.

If the DFI has moderate or high fragility, it can affect the fertilised egg so much that it does not develop normally in the laboratory. Even though the fertility clinic transfers the best embryos (fertilised eggs), the chances of pregnancy will be significantly reduced. The result may be either failure to become pregnant or a miscarriage.

Micro-insemination (ICSI)

icro Insemination ICSI
The graph shows the number of couples that have managed to become pregnant after their first test tube fertilisation (IVF), where the sperm DNA quality had low, moderate or high DFI (DNA Fragility Index). 196 couples took part in the study.
To take into account any miscarriages, the pregnancy numbers are based on positive scans in the 12th week of pregnancy.
The data is from Sims IVF (Dublin, The Republic of Ireland) and Fertility Center Hamburg (Germany), and was published at a European Fertility Conference (ESHRE) in 2013.

With micro-insemination, the sperm is placed directly into the egg. In this way both the journey to the egg and the fertilisation itself are avoided. The chances of pregnancy using micro-insemination are often higher than test-tube fertilisation or insemination.  

High DNA fragility means that some of the fertilised eggs will not develop normally. Even though embryos of good quality are implanted, pregnancy may fail to occur or there will be a miscarriage.

Dr. Declan Egan

Dr. Declan Egan, Galway Fertility, Ireland

At Galway Fertility we recommend to all couples that the sperm DNA integrity is tested prior to any fertility treatment. In many cases the couple can avoid treatments which are unlikely to succeed and thus saves time as well as money.
Dr. Declan Egan

Abstract from the European Fertility Conference

The results of the test tube fertilisation (IVF) and micro-insemination come from Hamburg Fertility Center (Germany), Sims IVF in Dublin (Ireland) and were published in connection with the European Fertility Conference (ESHRE) in 2013.

 
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