Correlation between the DNA fragmentation index (DFI) and sperm morphology of infertile patients

Abnormal sperm tails correlate with the sperm DNA fragmentation index, irrespective of progressive motility, according to an analysis of 5125 semen reports

PURPOSE

Sperm progressive motility (PR) is correlated with the sperm DNA fragmentation index (SDF). Moreover, abnormalities in sperm tails are closely associated with the quality of sperm PR. However, the correlation of abnormal sperm tails with the SDF remains unknown.

METHODS

Routine semen examination was performed according to the World Health Organization guidelines with a computer-assisted semen analysis system. SDF analysis was conducted via the sperm chromatin structure assay method. Spearman correlation was used to test the correlation of the SDF with age and conventional semen parameters. The relationship between the SDF and abnormal tails was explored by binary logistic regression analysis, restricted cubic spline (RCS) analyses and subgroup analysis. ROC curves were used to assess the predictive capacity of age, abnormal tails and PR for the SDF.

RESULTS

The SDF was associated with sperm morphology, with a significant correlation observed with abnormal sperm tails (r = 0.491, P < 0.001). Binary regression analysis revealed that abnormal sperm tails were an independent influencing factor of the SDF. RCS analyses and Trend analysis suggested that as the number of abnormal sperm tails increased, the risk of an abnormal SDF also increased, and the trend was statistically significant (P for trend < 0.001). The ROC curve demonstrated that abnormal sperm tails had good discriminatory ability for the SDF (AUC: 0.757, P < 0.001).

CONCLUSION

Abnormal sperm tails are an independent influencing factor of the SDF, and a higher number of abnormal tails is associated with an increased risk of an abnormal SDF.

Correlation analysis of a novel artificial intelligence optical microscope-assisted semen assessment system with IVF outcomes

PURPOSE

On the day of fresh oocyte retrieval in in vitro fertilization (IVF) cycles, a novel portable artificial intelligence optical microscope (AIOM) was employed to assist in the assessment of semen parameters. This study analyzed the correlation between sperm kinetic and morphological parameters with short-term IVF outcomes. Additionally, it explored whether these parameters could serve as predictive indicators for rescue intracytoplasmic sperm injection (R-ICSI) in IVF patients.

METHODS

A retrospective analysis was conducted on patients undergoing short-term IVF at the West China Second Hospital of Sichuan University between May 2021 and May 2024. Based on fertilization outcomes, the short-term IVF patients were categorized into a successful fertilization group (group A, n = 281) and a group requiring R-ICSI after failed fertilization (group B, n = 49). AIOM was utilized to analyze semen parameters including pH, sperm concentration, sperm motility parameters, sperm movement trajectory parameters, and sperm morphological parameters. The study further investigated the correlation between these short-term IVF fertilization-related laboratory indicators and IVF outcomes.

RESULTS

No statistically significant difference was observed in semen pH between the two groups. However, there were significant differences in sperm concentration and the majority of motility parameters. Specifically, compared to group A, patients in group B exhibited lower sperm concentration (p = 0.01), motility (p = 0.01), local motility (p = 0.01), progressive motility (PR) (p = 0.00), total motility (p = 0.01), and amplitude of lateral head displacement (ALH) (p < 0.01), along with higher immotility (p = 0.00). No statistically significant differences were found between the two groups in other sperm motility, velocity, or trajectory parameters. Additionally, sperm morphological parameters were also associated with short-term IVF fertilization outcomes. Compared to group A, group B had higher sperm head length mean (p < 0.01), head perimeter mean (p < 0.01), and head area mean (p = 0.01), as well as lower tail length mean (p = 0.01). Multivariate regression analysis of fertilization outcomes indicated that higher immotility (p = 0.01) and head length mean (p < 0.01), along with lower tail length mean (p = 0.04), were independent risk factors affecting successful short-term IVF fertilization. Notably, head length mean showed a significant negative correlation with polyspermy rate (p < 0.01), whereas tail length mean was significantly positively correlated with polyspermy rate (p < 0.01).

CONCLUSION

Optimization of semen parameters with AIOM at the time of fertilization is significantly associated with short-term IVF fertilization outcomes. Abnormal semen parameters at fertilization-specifically, higher immotility and head length mean, along with lower tail length mean-can be considered risk factors for fertilization failure and may serve as predictive indicators for potential R-ICSI.

Detection of sperm DNA damage in male infertility patients and evaluation of Levocarnitine efficacy using sperm chromatin diffusion (SCD) and AI-DFI methods: a cross-sectional study

The objective of this study was to elucidate the relationship between sperm DNA damage and sperm parameters in male infertility patients and to assess the changes in sperm DNA fragmentation index before and after treatment with Levocarnitine in patients with asthenozoospermia and oligozoospermia. The results of 508 patients' semen samples tested between August 2021 and December 2022 in our Department of Urology and Reproductive Medicine were retrospectively analyzed. The 508 patients were divided into 3 groups: normal semen group (n = 181), asthenozoospermia group (n = 170), and oligozoospermia group (n = 157). Their sperm DNA integrity was evaluated using the sperm chromatin diffusion (SCD) method and an artificial Intelligence-based DNA fragmentation index (AI-DFI). The patients were divided into two groups based on the assessment of sperm DNA integrity: a sperm DNA damage group and a sperm DNA integrity group. The two groups were then compared in terms of sperm concentration, motility, viability, and the proportion of normal sperm morphology. Pearson's correlation coefficient analysis was employed to examine the relationship between sperm DNA damage and semen parameters. The results showed that sperm concentration, progressive motility, viability, and normal morphology rate were significantly lower in the DNA damaged group, and correlation analysis showed that the results of sperm DNA damage detection was negatively correlated with these semen parameters. And the DNA fragmentation index (DFI) was highest in the asthenozoospermia group, followed by the oligospermia group and the normal group, with significant differences between the groups (20.30 ± 2.85; 18.62 ± 2.42; 12.83 ± 2.13, P = 0.01). Treatment of patients in the group with sperm DNA damage with Levocarnitine oral solution was found to significantly improve sperm concentration, progressive motility, viability, normal morphology rate, and DFI results after its use (t = 7.265, 5.823, 7.750, 8.737, 8.355; P = 0.03, 0.02, 0.02, 0.03, 0.01). This study concludes that men with asthenozoospermia and oligozoospermia have a high DFI, and Levocarnitine is effective in reducing DNA damage and improving sperm quality, suggesting that Levocarnitine has potential for clinical use.

High sperm DNA stainability might not be an accurate predictive indicator of male fertility and assisted reproductive technology outcomes

Background

The clinical need for assisted reproduction continued to increase, so did the need for predictive markers of assisted reproductive technology (ART) outcomes. Among all the markers, sperm DNA integrity was paid more and more attention in the assessment of male fertility in recent years, but its clinical value remains still in doubt.

Methods

We conducted a retrospective cohort study. Couples coming to our reproductive center were retrospectively enrolled, and semen and assisted reproductive technology parameters were assessed. Sperm DNA integrity was analyzed using a flow cytometric method. Statistics were analyzed to investigate the relationship of this on semen quality and ART outcomes.

Results

DNA fragmentation index (DFI) was affected by abstinence days and age, and was a directly correlated with sperm quality parameters (p<0.001). Meanwhile high sperm DNA stainability (HDS) showed an unexplainable negative correlation with abstinence days (p<0.05), age (p<0.001) and body mass index (p<0.01).For sperm quality parameters, HDS showed a similar relevance besides abnormal sperm head morphology (p<0.001). Embryo cleavage and implantation rates were significantly negatively related to DFI in fresh intracytoplasmic sperm injection cycles (p<0.01) while HDS showed a positive relationship with high quality embryo rate (p<0.05). For final outcomes, only the live birth rate from fresh intracytoplasmic sperm injection cycles was positively correlated with DFI which is meaningless (p<0.05).

Conclusions

HDS might not be an appropriate marker for male fertility and further studies are needed to identify the efficiency of SDF in clinical practice.

The correlation between abnormal Krüger strict morphology and the sperm DNA fragmentation index

OBJECTIVE

This study aims to investigate whether alterations in sperm DNA fragmentation rates are more frequent when Krüger strict morphology is ≥4% (normal).

METHODS

The retrospective study included 132 participants from March 2020 to November 2021. Participants were divided into two groups based on the inclusion criteria: normal and abnormal Krüger strict morphology, with a mean age of 40 years. Seminal analyses were conducted following the guidelines outlined in the 6th edition of the Manual for Examination and Processing of Human Semen (2021). The sperm chromatin dispersion test was used.

RESULTS

The results did not reveal a statistically significant difference between Krüger strict morphology and Sperm DNA Fragmentation Index correlation (p<0.05) between the normal and abnormal morphology groups (p<0.05) and in Seminal Parameters. Sperm concentration is lower when Krüger strict morphology is < 4% (abnormal) (p=0.007).

CONCLUSIONS

In conclusion, abnormal Krüger strict morphology does not have a higher predisposition to increased sperm DNA fragmentation.

Transcriptome analysis of human spermatozoa with different DNA fragmentation index using RNA sequencing

The study is aimed to screen the differential expressed genes (DEGs) related to sperm DNA fragmentation in men and provide reference basis of the sperm selection in assisted reproduction based on DNA fragmentation. We evaluated 60 semen samples from patients with high, medium or low sperm DNA fragmentation index (DFI). Using multicolor flow cytometry, we measured the content of reactive oxygen species (ROS), phosphatidylserine (PS) externalization and mitochondrial membrane potential (MMP) in these sperm samples. The results revealed that the more ROS content and PS externalization were detected in the sperm with higher DFI, but there was lower MMP level in the high DFI sperm. Next, we conducted RNA sequencing (RNA-seq) on 3 groups of sperm samples with high, medium and low DFI. Then, Gene Ontology (GO) enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were performed on DEGs. Furthermore, we utilized qRT-PCR to validated the significantly DEGs from the RNA-seq assay. The transcriptome results showed a total of 5334 DEGs were found in the sperm sample with high, medium and low DFI. According to GO and KEGG analysis 421 down-regulated genes in the high DFI group were related to oxidative stress and spermatogenesis. Thirteen novel genes were also identified that most likely were involved in sperm DNA fragmentation, which were further validated by qRT-PCR. In conclusion, our study suggested that the sperms with highly fragmented DNA were accompanied by down-regulation of a series of genes related to antioxidant and spermatogenesis.

Evaluation of the Prevalence and Potential Impact of HPV Vaccines in Patients with and Without Oral Diseases: A Ten-Year Retrospective Study

BACKGROUND

The prevalence of oral human papillomavirus (HPV) in the healthy population and patients with oral diseases such as oral squamous cell carcinoma (OSCC), oral potentially malignant disorders (OPMDs), and oral benign lesions (BL), is not consistently described in the literature, with scarce and often heterogeneous data. In addition, the efficacy of HPV prophylactic vaccines in preventing HPV-related oral disorders has been scarcely investigated.

METHODS

The prevalence of HPV and the potential impact of vaccines were analyzed in 1,415 oral rinse specimens, collected over 10 years and grouped into four categories based on histological/clinical diagnosis.

RESULTS

HPV prevalence in OSCC, OPMD, and BL patients and in healthy individuals potentially exposed to HPV (HPE) was comparable (12.7 vs. 27.2% vs. 13.5 vs. 9%). Statistical analysis of the vaccine impact involved calculating high and low estimates and showed a significant difference only for the low effect. The nonavalent vaccine had higher low estimates than the bivalent vaccine in OSCC and HPE patients (29.6 vs. 51.9%, p <0.05; 18.2 vs. 42.4%, p <0.05), while for OPMD and BL, the frequency of bivalent low estimates was lower than that of quadrivalent and nonavalent (48.6 vs. 68.6%, p <0.05 and 48.6 vs. 77.1%, p <0.05; 23.9 vs. 50.7%, p <0.05, and 23.9 vs. 63.4%, p <0.05).

CONCLUSIONS

This study provided new insights into the prevalence of oral HPV and showed that the nonavalent vaccine may provide better protection than the other vaccines in the presence of an OSCC diagnosis. Conversely, the quadrivalent vaccine may be sufficient to prevent OPMD and BL.

Predicting Boar Sperm Survival during Liquid Storage Using Vibrational Spectroscopic Techniques

Artificial insemination (AI) plays a critical role in livestock reproduction, with semen quality being essential. In swine, AI primarily uses cool-stored semen adhering to industry standards assessed through routine analysis, yet fertility inconsistencies highlight the need for enhanced semen evaluation. Over 10-day storage at 17 °C, boar semen samples were analyzed for motility, morphology, sperm membrane integrity, apoptosis, and oxidative stress indicators. Additionally, machine learning tools were employed to explore the potential of Raman and near-infrared (NIR) spectroscopy in enhancing semen sample evaluation. Sperm motility and morphology gradually decreased during storage, with distinct groups categorized as "Good" or "Poor" survival semen according to motility on Day 7 of storage. Initially similar on Day 0 of semen collection, "Poor" samples revealed significantly lower total motility (21.69 ± 4.64% vs. 80.19 ± 1.42%), progressive motility (4.74 ± 1.71% vs. 39.73 ± 2.57%), and normal morphology (66.43 ± 2.60% vs. 87.91 ± 1.92%) than their "Good" counterparts by Day 7, using a computer-assisted sperm analyzer. Furthermore, "Poor" samples had higher levels of apoptotic cells, membrane damage, and intracellular reactive oxygen species on Day 0. Conversely, "Good" samples maintained higher total antioxidant capacity. Raman spectroscopy outperformed NIR, providing distinctive spectral profiles aligned with semen biochemical changes and enabling the prediction of semen survival during storage. Overall, the spectral profiles coupled with machine learning tools might assist in enhancing semen evaluation and prognosis.

Sperm DNA Fragmentation: Unraveling Its Imperative Impact on Male Infertility Based on Recent Evidence

Male factors may be present in up to 50-70% of infertile couples and the prevalence of male infertility accounts for 20-30% of infertility cases. Understanding the mechanisms and causes behind male infertility remains a challenge, but new diagnostic tools such as DNA fragmentation might aid in cases where the routine semen analysis is insufficient. DNA fragmentation, which refers to damages or breaks of the genetic material of the spermatozoa, is considered one of the main causes of male infertility due to impaired functional capability of sperm. The aim of the present narrative review is to investigate and enlighten the potential correlation between DNA fragmentation and male infertility parameters such as the seminal profile and the reproductive outcomes. Comprehensive research in PubMed/Medline and Scopus databases was conducted and 28 studies were included in the present review. Fourteen studies provided data regarding the impact of DNA fragmentation and seminal parameters and showed a correlation of significantly lower sperm count, lower concentration, motility, and abnormal morphology with an increased DNA fragmentation index (DFI). Similarly, 15 studies provided data regarding the impact of DFI on reproductive outcomes. Two studies showed higher aneuploidy rates with higher DFI values, and seven studies showed significantly lower pregnancy rates and live birth rates with higher DFI values. Ultimately, the studies included in this review highlight, collectively, the importance of measuring sperm DFI in the assessment of male infertility. Further studies are needed to explore the effectiveness of interventions aiming to reduce DFI levels.

Exploring the full potential of sperm function with nanotechnology tools

Sperm quality is essential to guarantee the success of assisted reproduction. However, selecting high-quality sperm and maintaining it during (cryo)preservation for high efficiency remains challenging in livestock reproduction. A comprehensive understanding of sperm biology allows for better assessment of sperm quality, which could replace conventional sperm analyses used today to predict fertility with low accuracy. Omics approaches have revealed numerous biomarkers associated with various sperm phenotypic traits such as quality, survival during storage, freezability, and fertility. At the same time, nanotechnology is emerging as a new biotechnology with high potential for use in preparing sperm intended to improve reproduction in livestock. The unique physicochemical properties of nanoparticles make them exciting tools for targeting (e.g., sperm damage and sexing) and non-targeting bioapplications. Recent advances in sperm biology have led to the discovery of numerous biomarkers, making it possible to target specific subpopulations of spermatozoa within the ejaculate. In this review, we explore potential biomarkers associated with sperm phenotypes and highlight the benefits of combining these biomarkers with nanoparticles to further improve sperm preparation and technology.

Optimization of spermatozoa analysis in mice: A comprehensive protocol

Sperm quality is critical to predict reproductive alterations caused by immunological factors or toxicant agents. Yet, no detailed protocol has been published focusing on analyses of sperm parameters in mice. Our aim was to evaluate the most efficient diluent for mice sperm analyses and to optimize the sperm morphology classification, through the comparison of different staining methods. The diluents assessed were PBS (baseline), HTF, DMEM, 1 % BSA in PBS and 9 % skimmed powdered milk diluted in PBS. Spermatozoa were evaluated for vitality, motility, and morphology, smears were stained with Papanicolaou, HE, Giemsa, and Rapid staining. Sperm vitality and total motility reached better scores in milk based and DMEM diluents. HE raised up as an effective option since its combination with any of the diluents we tested, resulted in a fair staining, which was appropriated to evaluate mice spermatozoa. Finally, based on WHO manual, we have updated the current morphological classification for mice sperm, since we have detailed the head defects as well as included midpiece and tail defects on it. Taken together, we presented a useful, low cost, and reliable method to assess sperm morphology that could be employed worldwide by laboratories dedicated to study reproductive biology on mice model.

Enhancing Intracytoplasmic Sperm Injection Outcomes With Zeta Sperm Selection: A Case Report

Sperm morphology significantly influences the fertilization capacity of male germ cells. Morphological abnormalities are frequently associated with an overproduction of reactive oxygen species (ROS), leading to further sperm damage and subsequent infertility. This case study examines a couple facing infertility, with male factor infertility identified as the primary issue, characterized by teratozoospermia and a high DNA fragmentation index (DFI). The objective was to assess the efficacy of zeta potential (ZP) as a sperm sorting technique for intracytoplasmic sperm injection (ICSI) in patients showing high DNA fragmentation. A 34-year-old male with abnormal sperm parameters underwent ICSI using the ZP technique for sperm separation, while his 28-year-old female partner received ovarian stimulation. This intervention resulted in the development of two good-quality blastocysts, resulting in a successful embryo transfer (ET) and a positive pregnancy outcome. Previous attempts using conventional assisted reproductive technologies (ART), including in vitro fertilization (IVF), followed by ICSI and ET, as well as other sperm selection methods, were not successful. The ZP-based approach demonstrated significant benefits by selecting spermatozoa with optimal parameters, such as negative membrane potential, thereby enhancing the success rate. This case emphasizes the advantages of personalized treatment strategies in managing male infertility and highlights the potential of advanced sperm sorting techniques in improving fertility outcomes.

Pattern and value of Sperm DNA Fragmentation Index and its correlation with spermiogram in infertile South West Nigerian Men

Semen analysis has been used for a long time to assess male fertility due to its limitations sperm DNA fragmentation index (DFI), which describes the sperm DNA's condition, is an appropriate criterion for assessing male fertility. This study evaluated the pattern and value of DFI of infertile men in the South West of Nigeria. This is a cross-sectional and descriptive study that recruited two hundred and eighty-seven (287) patients from two fertility centers in Lagos, Nigeria. The Sperm DFI was determined using the Sperm chromatin structure assay (SCSA) test. The descriptive and inferential statistics of the study were carried out using R packages (R version 4.2.0) with the help of R functions using compiled code. The result showed that the mean age sperm concentration, total motility morphology, and DFI were as follows 42.96±7.09years, 40.18±4.19×106 per ml, 49%±19%, 56±17%, and 15.78±8.52 respectively. There is a significant negative correlation between sperm concentration and DFI at a P-value of 0.0018 with a regression model of Coefficient of determination is 0.305. The DFI value of infertile men negatively correlates with sperm concentration, thus increase sperm production may improve sperm quality.

Correlation of Sperm DNA Fragmentation Index With Semen Parameters, Lifestyle and Clinical Pregnancy Outcome After Intracytoplasmic Injection

Objective

This study aimed to measure the correlation of sperm DNA fragmentation with semen parameters, lifestyle, and fertility outcomes after intracytoplasmic injection (ICSI).

Materials and methods

The partners who were candidates for ICSI with a history of one In vitro fertilization (IVF) failure or male factor were recruited in the study. Semen parameters including sperm count, motility, and morphology as well as DNA fragmentation index (DFI) (that were divided into 2 groups as high (>15%), and low (≤15%) fragmentation scales) were evaluated either. The correlation of DFI with semen parameters, lifestyle, and clinical pregnancy after ICSI were compared between groups.

Results

In 120 included couples, 59 men (49.2%) had DFIs ≤ 15% and 61 (50.8%) cases had DFIs >15%. In the group with higher DFI, abnormal morphology (p=0.010) was higher whereas, progressive motility (p=0.001), total motility (p<0.001), and total count (p<0.001) of sperm were significantly lower. In addition, the DFI was significantly higher in the subgroup of male infertility (0.012). Logistic regression showed that a lower risk of DFI>15% was associated with higher values of progressive motility (OR=0.97, p=0.001), total motility (OR=0.96, p=<0.001), count (OR=0.96, p=<0.001) and even clinical pregnancy (OR=0.27, p=0.011). However, a history of testicular surgery was associated with a higher risk of DFI>15% (OR=3.37, p=0.046). Although no correlation was found between male age and lifestyle components with DFI, the number of embryos was lower in DFI≥15% (p<0.001).

Conclusion

DFI provide a clinically important measurement of sperm quality and have an impact on IVF outcomes; however, lifestyle components may not correlate with DFI.

Decreased AKAP4/PKA signaling pathway in high DFI sperm affects sperm capacitation

The sperm DNA fragmentation index (DFI) is a metric used to assess DNA fragmentation within sperm. During in vitro fertilization-embryo transfer (IVF-ET), high sperm DFI can lead to a low fertilization rate, poor embryo development, early miscarriage, etc. A kinase anchoring protein (AKAP) is a scaffold protein that can bind protein kinase A (PKA) to subcellular sites of specific substrates and protects the biophosphorylation reaction. Sperm protein antigen 17 (SPA17) can also bind to AKAP. This study intends to explore the reason for the decreased fertilization rate observed in high sperm DFI (H-DFI) patients during IVF-ET. In addition, the study investigates the expression of AKAP, protein kinase A regulatory subunit (PKARII), and SPA17 between H-DFI and low sperm DFI (L-DFI) patients. SPA17 at the transcriptional level is abnormal, the translational level increases in H-DFI patients, and the expression of AKAP4/PKARII protein decreases. H 2 O 2 has been used to simulate oxidative stress damage to spermatozoa during the formation of sperm DFI. It indicates that H 2 O 2 increases the expression of sperm SPA17 protein and suppresses AKAP4/PKARII protein expression. These processes inhibit sperm capacitation and reduce acrosomal reactions. Embryo culture data and IVF outcomes have been documented. The H-DFI group has a lower fertilization rate. Therefore, the results indicate that the possible causes for the decreased fertilization rate in the H-DFI patients have included loss of sperm AKAP4/PKARII proteins, blocked sperm capacitation, and reduced occurrence of acrosome reaction.

Human Papillomavirus and Male Infertility: What Do We Know?

In recent years, increasing attention has been paid to understanding the causes of infertility, which is being recognized as a growing health problem affecting large numbers of couples worldwide. Male infertility is a contributing factor in approximately 30-40% of cases, and one of its etiological causes is sexually transmitted infections (STIs). Among sexually transmitted pathogens, human papillomavirus (HPV) can contribute in various ways to the failure of spontaneous and assisted reproduction, acting in the different phases of conception, especially in the early ones. In particular, HPV infection can affect sperm DNA integrity, sperm motility, count, viability, and morphology and can induce the production of anti-sperm antibodies (ASAs). In this narrative review, we aimed to provide an overview of existing research on the potential adverse effects of HPV infection on male reproductive health. Furthermore, we analyzed how limiting the spread of the infection, particularly with gender-neutral vaccination, could be a possible therapeutic tool to counteract male and female fertility problems.

Epidemiology of sperm DNA fragmentation in a retrospective cohort of 1191 men

BACKGROUND

The scientific and clinical communities now recognize that sperm DNA integrity is crucial for successful fertilization, good embryo development, and offspring quality of life. Despite the apparent unanimity, this criterion is rarely evaluated in clinical practice. We evaluated the sperm DNA fragmentation index of nearly 1200 sperm samples and its connections based on the patient's age, body mass index, the season of sperm collection, geographical location, medical history, and addictive behaviors.

METHODS

A cohort of 1503 patients who were referred to the Royan Institute between July 2018 and March 2020 was examined. Only 1191 patient records with demographic data, complete semen analysis, and DNA fragmentation index measurements were included in the final cohort. Documents were classified, incorporated into statistical models, and analyzed.

RESULTS

The results confirmed previous findings that the sperm DNA fragmentation index was significantly higher in aging men. The sperm DNA fragmentation index and high DNA stainability levels were significantly higher in spring and summer samples than in those of other seasons. No correlation was found between semen DNA fragmentation index and patient body mass index, although the study cohort was significantly overweight. Contrary to what might be expected, we observed that the sperm DNA fragmentation index was higher in rural than in urban patients. Intriguingly, epileptic patients exhibited significantly higher sperm DNA fragmentation index levels.

DISCUSSION AND CONCLUSION

Age is the factor that is most strongly associated with sperm DNA fragmentation index levels. Our analysis of 1191 samples indicates that between the ages of 19 and 59, the sperm DNA fragmentation index increases by an average of 2% each year. Intriguingly, from an epidemiological perspective, the warm season (spring/summer) is associated with a higher sperm DNA fragmentation index in the study population, possibly due to the deleterious effect of temperature on sperm quality. Some neurological diseases, such as epilepsy, are associated with decreased sperm DNA integrity. This observation could be related to the iatrogenic effects of associated therapies. In the study cohort, body mass index did not appear to be correlated with the DNA fragmentation index.

Transition nuclear protein 1 as a novel biomarker in patients with fertilization failure

OBJECTIVE

Although intracytoplasmic sperm injection (ICSI) is a way to deal with in vitro fertilization failure, 3% of couples still experience repeated fertilization failure after attempted ICSI, despite having sperm within normal parameters. These patients are a challenging group whose sperm cannot fertilize the egg during ICSI. Unfortunately, no test can predict the risk of fertilization failure. Phospholipase C zeta (PLCζ) and transition nuclear proteins (TNPs) are essential factors for chromatin packaging during sperm maturation. This study aimed to assess PLCζ1 and TNP1 expression in the sperm of patients with fertilization failure and the correlations among the DNA fragmentation index, PLCζ1 and TNP1 gene and protein expression, and the risk of fertilization failure.

METHODS

In this study, 12 infertile couples with low fertilization rates (<25%) and complete failure of fertilization in their prior ICSI cycles despite normal sperm parameters were chosen as the case group. Fifteen individuals who underwent ICSI for the first time served as the control group. After sperm analysis and DNA fragmentation assays, quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and Western blot analyses were performed to compare the gene and protein expression of PLCζ and TNP1 in both groups.

RESULTS

DNA fragmentation was significantly higher in the fertilization failure group. The qRT-PCR and Western blot results demonstrated significantly lower PLCζ and TNP1 gene and protein expression in these patients than in controls.

CONCLUSION

The present study showed that fertilization failure in normozoospermic men was probably due to deficient DNA packaging and expression of TNP1.

The Impact of Origanum vulgare Supplementation on Human Asthenozoospermic Sperm Parameter Quality

Male infertility is a complex multifactorial disease and a real health problem; 50% of infertile men have identifiable causes detectable by fundamental sperm analysis. Numerous research studies have shown the possibility of treating abnormal semen samples with some drugs before artificial insemination, yet evidence of the drug's effectiveness remains minimal. In our previous work, we tested the effectiveness of some essential oils, such as eucalyptus (Eucalyptus globulus Labill.), oregano (Origanum vulgare L.), and sage (Salvia officinalis L.) on sperm parameters. The essential oil of oregano showed the best ameliorative effect. In present, we examined the effect of the essential oil of O. vulgare on the physiological parameters and the specific activity of certain antioxidant enzymes such as catalase (CAT), superoxide dismutase (SOD), lipid peroxidation rate (MDA), and GAPDH and antioxidant and metabolic biomarkers, characterizing the quality of human sperm. The results showed that in vitro supplementation of oregano significantly improves the mobility and antioxidant activities, without harmful effects on the integrity of the sperm's DNA, and that the selected concentration of oregano EO is nontoxic and may be considered a therapeutic alternative to heal sperm motility problems in asthenozoospermic patients.

How Well Do Semen Analysis Parameters Correlate with Sperm DNA Fragmentation? A Retrospective Study from 2567 Semen Samples Analyzed by the Halosperm Test

Sperm DNA fragmentation (SDF) levels have been measured in the workup for in vitro fertilization (IVF) at PIVET since 2007, with the Halosperm test having replaced the previous sperm chromatin structure assay (SCSA) since 2013. Of 2624 semen samples analyzed for the Halosperm test, 57 were excluded as the sperm concentration was <5 million/mL, a level too low for accurate testing, leaving 2567 samples for assessment within this study. The SDF rates were categorized in 5 sperm DNA fragmentation indices (DFI), ranging from <5% to levels >30%, and these categories were correlated with the respective semen analysis profiles and two clinical parameters, namely the age of the male and the ejaculatory abstinence period prior to the sample. The results showed a significant correlation with male age (r = 0.088; p < 0.0001), the abstinence period (r = 0.076; p = 0.0001), and the semen volume (r 0.063; p = 0.001), meaning an adversely high SDF was associated with advanced age, prolonged abstinence, and raised semen volume parameters. There was a significant negative correlation with sperm morphology (r = −0.074; p = 0.0001), progressive motility (r = −0.257; p < 0.0001), and semen pH (r = −0.066; p < 0.001), meaning these semen anomalies were associated with high SDF values. With respect to abnormal morphology, sperm tail defects had a positive correlation (r = 0.096; p < 0.0001) while midpiece defects showed a negative correlation (r = −0.057; p = 0.004), meaning that tail defects are most likely to associate with adverse DFI values. With respect to motility patterns, the poorer patterns showed a positive correlation with increased DFI, namely C pattern (r = 0.055; p = 0.005) and D pattern (r = 0.253; p < 0.0001). These results imply that raised DFI reflects poor sperm quality and should be investigated in clinical trials involving IVF and the consideration of intracytoplasmic sperm injection (ICSI).

Assisted Oocyte Activation following Intracytoplasmic Sperm Injection: A Sensible Option for Infertile Couples with Severe Teratozoospermia

The intracytoplasmic sperm injection (ICSI) has significantly improved male factor infertility treatment; however, complete fertilization failure still occurs in 1-5% of ICSI treatment cycles mainly due to oocyte activation failure. It is estimated that around 40-70% of oocyte activation failure is associated with sperm factors after ICSI. Assisted oocyte activation (AOA) as an effective approach to avoid total fertilization failure (TFF) has been proposed following ICSI. In the literature, several procedures have been described to overcome failed oocyte activation. These include mechanical, electrical, or chemical stimuli initiating artificial Ca²⁺ rises in the cytoplasm of oocytes. AOA in couples with previous failed fertilization and those with globozoospermia has resulted in varying degrees of success. The aim of this review is to examine the available literature on AOA in teratozoospermic men undergoing ICSI-AOA and determine whether the ICSI-AOA should be considered as an adjunct fertility procedure for these patients.

Pentoxifylline treatment had no detrimental effect on sperm DNA integrity and clinical characteristics in cases with non-obstructive azoospermia

The aim of this study was to assess the consequences of treatment with pentoxifylline (PTX), an inducer of sperm motility, on sperm DNA fragmentation (SDF) and clinical characteristics in non-obstructive azoospermia (NOA) patients. The pilot study included 15 NOA patients. Half of each sperm sample before and after rapid freezing, was treated with PTX (3.6 mM /l, 30 min) as the PTX group and the remaining samples were considered as the control. SDF and sperm motility were assessed in each group. The clinical study comprised 30 fresh testicular sperm extractions (TESE) and 22 post-thawed TESE intracytoplasmic sperm injection cycles. Half of the mature oocytes from each patient were injected with PTX-treated spermatozoa and the remaining oocytes were injected with non-treated spermatozoa. Fertilization was assessed at 16 h post injection. Embryo transfer was carried out on day 2 after fertilization. Chemical pregnancy was assessed 2 weeks after transfer. PTX was found to significantly increase (P < 0.05) sperm motility. There was an insignificant difference in SDF rates between the groups (P > 0.05). In patient ovaries given fresh TESE, there was not any significant difference in clinical characteristics (P > 0.05). In patient ovaries given post-thawed TESE, there was a significant difference in the number of 2PN and in embryo formation (P < 0.05). Differences in the results of chemical pregnancy were insignificant (P > 0.05) between the groups. In addition, there was not any correlation between DNA fragmentation index and sperm motility and laboratory outcomes. Therefore, obtaining viable spermatozoa using PTX was more effective in post-thawed TESE regime patients in terms of 2PN and in embryo formation, deprived of damaging effects on sperm DNA integrity.

Deep Learning-Based Robust Automated System for Predicting Human Sperm DNA Fragmentation Index

Background

Determining the DNA fragmentation index (DFI) by the sperm chromatin dispersion (SCD) test involves manual counting of stained sperms with halo and no halo.

Aims

The aim of this study is to build a robust artificial intelligence-based solution to predict the DFI.

Settings and Design

This is a retrospective experimental study conducted in a secondary in vitro fertilisation setup.

Materials and Methods

We obtained 24,415 images from 30 patients after the SCD test using a phase-contrast microscope. We classified the dataset into two, binary (halo/no halo) and multiclass (big/medium/small halo/degraded (DEG)/dust). Our approach consists of a training and prediction phase. The 30 patients' images were divided into training (24) and prediction (6) sets. A pre-processing method M was developed to automatically segment the images to detect sperm-like regions and was annotated by three embryologists.

Statistical Analysis Used

To interpret the findings, the precision-recall curve and F1 score were utilised.

Results

Binary and multiclass datasets containing 8887 and 15,528 cropped sperm image regions showed an accuracy of 80.15% versus 75.25%. A precision-recall curve was determined and the binary and multiclass datasets obtained an F1 score of 0.81 versus 0.72. A confusion matrix was applied for predicted and actuals for the multiclass approach where small halo and medium halo confusion were found to be highest.

Conclusion

Our proposed machine learning model can standardise and aid in arriving at accurate results without using expensive software. It provides accurate information about healthy and DEG sperms in a given sample, thereby attaining better clinical outcomes. The binary approach performed better with our model than the multiclass approach. However, the multiclass approach can highlight the distribution of fragmented and non-fragmented sperms.

Correlations between abnormalities of morphological details and DNA fragmentation in human sperm

Objective: As the associations of sperm DNA fragmentation with morphology have not been examined in detail, this study aimed to investigate the relationship between abnormalities of morphological details and DNA integrity in human sperm.Methods: In this cross-sectional study, men from infertile couples were enrolled at Hue Center for Reproductive Endocrinology and Infertility, Vietnam. Conventional semen parameters, including morphological details, were analyzed following the World Health Organization 2010 criteria. Sperm DNA fragmentation was evaluated using a sperm chromatin dispersion assay. The relationships and correlations between semen parameters, sperm morphology, and the type of halosperm and the DNA fragmentation index (DFI) were analyzed.Results: Among 130 men in infertile couples, statistically significant differences were not found in the sperm halo type between the normal and abnormal sperm morphology groups. The percentage of round-head spermatozoa was higher in the DFI >15% group (16.98%±12.50%) than in the DFI ≤15% group (13.13%±8.82%), higher values for amorphous heads were found in the DFI >15% group, and lower values for tapered heads were observed in the DFI ≤15% group; however, these differences were not statistically significant. Small-halo sperm and the DFI were positively correlated with round-head sperm (r=0.243, p=0.005 and r=0.197, p=0.025, respectively). Conclusion: The rate of general sperm morphological abnormalities in semen analysis was not related to sperm DNA integrity. However, round sperm heads were closely associated with sperm DNA fragmentation.

Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles

Background

An explosive increase in couples attending assisted reproductive technology has been recently observed, despite an overall success rate of about 20%–30%. Considering the assisted reproductive technology‐related economic and psycho‐social costs, the improvement of these percentages is extremely relevant. However, in the identification of predictive markers of assisted reproductive technology success, male parameters are largely underestimated so far.

Study design

Retrospective, observational study.

Objectives

To evaluate whether conventional semen parameters could predict assisted reproductive technology success.

Materials and methods

All couples attending a single third‐level fertility center from 1992 to 2020 were retrospectively enrolled, collecting all semen and assisted reproductive technology parameters of fresh cycles. Fertilization rate was the primary end‐point, representing a parameter immediately dependent on male contribution. Pregnancy and live birth rates were considered in relation to semen variables. Statistical analyses were performed using the parameters obtained according to the World Health Organization manual editions used for semen analysis.

Results

Note that, 22,013 in vitro fertilization and intracytoplasmic sperm injection cycles were considered. Overall, fertilization rate was significantly lower in patients with abnormal semen parameters compared to normozoospermic men, irrespective of the World Health Organization manual edition. In the in vitro fertilization setting, both progressive motility (p = 0.012) and motility after capacitation (p = 0.002) significantly predicted the fertilization rate (statistical accuracy = 71.1%). Sperm motilities also predicted pregnancy (p < 0.001) and live birth (p = 0.001) rates. In intracytoplasmic sperm injection cycles, sperm morphology predicted fertilization rate (p = 0.001, statistical accuracy = 90.3%). Sperm morphology significantly predicted both pregnancy (p < 0.001) and live birth (p < 0.001) rates and a cut‐off of 5.5% was identified as a threshold to predict clinical pregnancy (area under the curve = 0.811, p < 0.001).

Discussion

Interestingly, sperm motility plays a role in predicting in vitro fertilization success, while sperm morphology is the relevant parameter in intracytoplasmic sperm injection cycles. These parameters may be considered reliable tools to measure the male role on ART outcomes, potentially impacting the clinical management of infertile couples.