Sperm DNA fragmentation index (DFI)

October 22, 2011Carole 55 Comments »

One of my readers asked me my opinion of the sperm DNA fragmentation index or DFI. The value of any clinical test depends on a number of factors. Is the test relatively easy to perform or is it subject to exceptional end user skill and ideal test conditions? Some research lab tests don’t translate well to the clinical testing world. Does the test have good predictive value so that results can be reliably used to inform patients regarding their treatments? In other words, is there enough correlation between test results and real world pregnancy outcomes to know if test results are meaningful in predicting pregnancy outcomes with intercourse, insemination, IVF or ICSI? Even if useful, are there other factors that already dictate the most aggressive treatment plan (ICSI) regardless of the DFI result?

If ICSI is to be used,  can the test be used to select sperm for ICSI or is the test just used to describe the parameters of a population of cells, most of which will not be chosen for sperm injection? This last factor is what makes a test useful to the embryologist. My issue with another “advanced” semen analysis test,  Kruger’s strict criteria, is that although very poor test results (percent normal less than 5%) is used to drive a couple to having ICSI added to their treatment plan, it is worthless to the embryologist who will choose a sperm for ICSI that “looks good” from a much lower magnification and without any measurement of sperm head that is specific to Kruger. It’s like identifying the best fruit from a bucket at your feet (Kruger’s strict) but then taking home some fruit that lies in a bin twenty feet away (selecting sperm for ICSI).

The DNA fragmentation index is a score based on the percent of cells that have detectable sperm degradation. The value of the test is based on the idea that sperm vary in the amount of fragmentation found in the DNA stands stored in the sperm head and that having lots of sperm with lots of DNA degradation is likely to translate into poor pregnancy rates.

What causes DNA fragmentation? Some fragmentation may be due to apoptosis or cell suicide, a natural mechanism that cells use to get rid of old cells or to remove excess cells that are not needed in the final developmental plan for that tissue or organ.  But these normal mechanisms of cell removal are probably not the major factor that accounts for high levels of sperm DNA fragmentation that negatively affect reproduction.

Various environmental factors such as radiation, chemotherapy drugs, some prescribed medications, pesticides, smoking, some chemicals and high heat exposure all have been shown to negatively affect sperm DNA integrity.  Some medical conditions such as cryptorchidism (undescended testicle), cancer , varicocele, fever, advanced age and infection can also affect sperm DNA integrity. Some of these causes may indirectly raise the amount of reactive oxygen species (ROS) in the sperm’s local environment. ROS is then directly responsible for causing DNA strand breaks. Some ROS activity is required for normal gene and protein activities that are necessary in sperm production. Too much ROS is destructive. Fertile men are believed to have adequate levels of natural antioxidants to keep excess ROS in check. Varicocele (a varicose vein in the testicle) repair has also been attributed to improved DFI scores.  Some patients and clinical reports suggest that antioxidant therapy (for instance, taking vitamins like Vitamin C which have antioxidant properties) may decrease ROS levels, allowing more sperm DNA to remain intact.

The sperm chromatin structure assay (SCSA) is probably the most common clinical test used to determine a DFI score although other tests such as the Comet assay, Tunel assay and acridine orange test are routinely used in research labs. For those of you who want to know about the various techniques that can be used and a review of clinical use of the DFI , might find the paper  “Clinical aspects of sperm DNA fragmentation and male infertility“, useful and it is available for free download. Another good reference for readers interested in the details of sperm production, DNA integrity and ROS might be “Sperm chromatin structure and male fertility: biological and clinical aspects”, also available for free download.

From the  Georgetown Male Factor Infertility study, three broad categories of DFI results and fertility prognosis were derived.

  • Greater than 30% fragmentation : poor fertility prognosis
  • Between 15 and 30% fragmentation: reasonable fertility status
  • Less than 15% fragmentation: good fertility prognosis.

As it turns out, this rule of thumb is pretty reliable for predicting outcomes for intercourse and IUI. For instance, if a man has less than 15% fragmentation, AND assuming no female issues, he has an excellent chance of getting his partner pregnant with intercourse or IUI.  On the other hand, if his DFI is higher than 30%, the probability of pregnancy success with intercourse or IUI is dismal. Of course, these are probabilities, not guarantees. You are looking at a population of sperm and there is no way to know which sperm will successfully enter the egg. Ironically, sperm with DNA integrity problems don’t necessarily have any trouble entering the egg and may even fertilize the egg and create embryos. But in spite of this initial success, embryos derived from sperm with poor DNA integrity are at greater risk for failure later in the development program. The miscarriage rate observed from pregnancies where the male DFI is greater than 30% is  higher than in pregnancies where the male partner had a very low DFI score. .

DFI  scores are less useful in predicting success with IVF and especially with ICSI. Clinics have reported pregnancy outcomes that are better than expected based on DFI when ICSI is used. This is surprising because there is no way to identify individual sperm which have intact DNA by looking at them. And looking at them at relatively low magnification is still the way the embryologist selects a sperm to be injected. So these favorable results with ICSI can not be attributed to selection of better sperm. Some researchers have proposed that ICSI,  by bypassing the natural egg-sperm interactions and getting the sperm into the egg, is enough to get the ball rolling and then the egg can repair some of the DNA damage and support at least the early stages of embryo development. However, the miscarriage rate is still higher with higher DFI scores than lower DFI scores, even if ICSI is used to establish the pregnancy.

Not all clinicians are convinced that the DFI is useful for reasons that have nothing to do with the validity of the test.  It is yet another test for couples who may be emotionally (and financially) fatigued by the increasing list of diagnostic tests offered to both male and female. In many ART programs, ICSI is already the “go to” solution for any number of infertility diagnoses so another test to direct the clinician to use ICSI is not really useful. Some clinicians use ICSI for any history of male infertility without an obvious cause, in recognition of the fact that molecular problems are not detectable by routine semen analysis. DFI scores are probably most useful to decide whether there is a reasonable expectation of pregnancy with intercourse or insemination and thus may be more useful to the primary doctor or OBGyn who may do some preliminary infertility diagnosis and treatment, rather than the REI whose treatment plan will more quickly include more aggressive treatments like IVF and ICSI.

So what is my opinion of DFI? I think it may be a useful test for some clinicians, especially when they are trying to decide between intercourse or IUI and more aggressive treatments. For the embryologist, once ICSI is ordered, the DFI index does not help the embryologist select the best sperm and so has no value for the embryologist.

 

© 2011, Carole. All rights reserved.

55 Responses to this entry

  • Kelly Says:

    Thank you for posting this, very informative and timely. I’ve done 2 IVFs, we have low motility issues and have used ICSI. I had a second opinion and they mentioned doing this test as my current RE has not done it. It sounds like based on your summary that this test wouldn’t hold much value for us since we are going ICSI anyhow.

    Thank you for your posts, they are very helpful and well written.

  • Miela Says:

    Hi, we have never done the fragmentation test, but with 1-2% morphology the fragmentation will probably be really high? Right?

    After 3 miscarriages my FS is nou trying to convince us that it might be my eggs and that we need to consider DE, but it might just be that we have really terrible sperm?

    With IMSI almost no normal forms could be found…

  • Carole Says:

    Hi Miela,
    Fragmentation of DNA may be correlated with poor morphology (http://www.ncbi.nlm.nih.gov/pubmed/19732195) but not necessarily. They can be independent. I really don’t know why you aren’t getting pregnant. It seems to me that you have put a lot of emotional energy and probably financial reserves into IVF and it really has not been very effective for you. The things you can do from here are even more expensive and may not give you more answers and may not work. It might be time to take a big breath and think about the big picture and how best to get to parenthood. Whatever youd decide, I wish you the very best!! Carole

  • Anonymous Says:

    How can DNA be fragmented yet using ICSI fixes that? You can’t fix bad DNA can you? If there are defects in the DNA, then ICSI or not will you not have a poor outcome? Maybe I’m oversimplifying it. I’m trying to make sense of all the egg quality issues I’m told I have. There seems to be a lot resting on the women’s shoulders where infertility is concerned.

  • Carole Says:

    Hi Anonymous,
    You are correct, ICSI will not fix a problem with fragmented sperm DNA. The only thing that ICSI does reliably is ensure that the sperm enters the egg. That’s all. And sperm entry alone is not sufficient for fertilization, but it is a required early step. ICSI may be helpful because IF you happen to get hold of a DNA-normal sperm, you can ensure the first step gets done, but it can’t fix or improve a sperm. There is some evidence that using hyaluronate-binding is one method to select more fertilization-ready, higher quality sperm. HA binding may help select for sperm with the correct number and type of chromosomes. There is some evidence that HA-binding has also been found effective for selecting non-fragmented sperm http://www.ncbi.nlm.nih.gov/pubmed/20034422, but there is by no means universal agreement that HA-binding is the answer for selecting high quality sperm. So, ICSI can’t fix sperm, but some sperm selection methods that are used to select sperm prior to ICSI may boost the ICSI success rates from a population of mixed high and low quality sperm. And yes, when it comes to human production, women do the heavy lifting. Hope this helps. Good Luck! Carole

  • Sally76 Says:

    Hi Carole,

    My husband has DNA fragmentation levels of 37%. We are starting our fourth cycle and have been offered either IMSI or PICSI — apparently, it’s not possible to have both.

    In our last cycle, all of my retrieved eggs (five) fertilised with IMSI and we had a chemical pregnancy. This was a big increase over the previous cycle, when only two out of five eggs fertilised with ICSI. So, we assumed that we’d use IMSI again.

    This time however, at a new clinic, they’re recommending PICSI over IMSI (but they’re leaving the decision to us). Would you have any opinion on this? We’re desperate at this stage…many thanks in advance.

  • Carole Says:

    Hi Sally,
    I am sorry you are having a tough time. If there are sufficient sperm, then PICSI is a useful tool to select the most mature sperm on the basis of a functional criteria, namely, their ability to bind to a carbohydrate -hyaluronan. This ability is a necessary skill for regular fertilization for egg binding but is also a sign that the sperm maturation process is complete. I have never used IMSI- but it is based on getting an even closer look at the sperm- they are more highly magnified during selection for ICSI- but there is no functional selection. Since the lab is offering PICSI, they must have good experience with it and it also has the added advantage of being able to provide some functional basis for selection, not just physical appearance. Good Luck!!

  • Andy Says:

    My wife had low egg reserve and my sperm parameters were all great but after a few failed IVF attempts, including donor eggs I had a sperm comet test (uk). Results were bad 56%. I eat healthily, don’t smoke, drink only a little so I took an expensive anti-oxidant supplement. Test 3 months later showed at 26%. We had a positive pregnancy test recently and there was a heartbeat at 7 weeks. We have our 12 week scan this week and I am petrified. I have read so much on-line about increased miscarriage with higher DNA fragmentation, but since we had our good news it has slipped to the back of our minds. Everyone tells me the chance of miscarriage plummets to 5% once a heartbeat has been detected and we are delighted with our result but then I am not so sure. The DNA fragmentation is a big question mark that keeps me awake at night. Increased miscarriage rate, birth defects, autism? Am I right to be worried?

  • Carole Says:

    Hi Andy,
    Your concern is understandable but I think you need to focus on the positive. A heart beat was detected at 7 weeks!! That is great news. Everything is moving in the right direction. So please try not to worry –it does no good. But you are learning early what every father knows- you wear your heart on your sleeve when you have a child. Enjoy this moment– so far, it is all good!!–and may well stay that way. Wishing you and your wife much good luck moving forward. Carole

  • Sushmitha Says:

    Hi… We are going through this problem of high DNA Fragmentation index.. It’s 75%… Already had two miscarriage… One was blighted ovum and next was miscarriage at 8weeks after heart beat had appeared.. And both were natural conception. This time we went to infertility centre.. N got the report of high abnormal sperms n they suggested for iui.. In the mean time DNA frag test was sent… N on the day I underwent blood beta hcg test.. DNA frag report was disclosed.. N it’s very high… I am now 5 weeks pregnant… But very worried, I am put on clexane, low molecular weight heparin and had bleeding after three days… Scan shows gestational sac n bleeding from other places… My doc has asked me to continue clexane… N I really don’t know where this pregnancy is going to end… Hope for the best… Has anyone had a healthy baby with high DFI…???

  • Carole Says:

    Hi Sushmitha,
    Yes, it is possible to have the gestational sac bleeding and still go on to have a normal pregnancy but it is a more difficult situation. Wishing you all the best and a good outcome!!

  • Sushmitha Says:

    Hi… Carole,
    Thank you… Now I am in eight week.. Going for weekly scan tomw.. Hope things r ok… I stopped that clexane on my own as every day i had spotting with a good scan … After four days it was completely normal no more bleed…. Again started last week thinking I shouldn’t decide on my own… After four days, I passed clots again,.. Now definitely no to clexane… Hope this pregnancy results in a viable baby…

  • Carole Says:

    Dear Sushmitha,
    I wish you MUCH GOOD LUCK and a good healthy pregnancy!! Carole

  • Michelle Says:

    Andy – what is the name of the antioxidant you took? What kind of dose did you take?

  • mike Says:

    But wouldn’t knowledge of the DFI through SCSA testing indicate the need to seek available alternatives for improving the DFI, whether it be treatment or undergoing a more invasive procedure in order to attempt to increase the quality of sperm identified for IVF, even if the ultimate selection process can’t identify fragmentation?

  • Carole Says:

    Hi Mike,
    Good question. Yes, it might make a difference to know what you are up against- but I am not sure there are any proven treatments that help improve sperm quality reliably–because so many things can impact sperm fragmentation. My point was that once ICSI is ordered, this additional data doesn’t impact what the embryologist does in the lab and which sperm gets selected.

  • Haratua Says:

    Dear Carole and Andy…could you Share the antioxydant you used since my DFI results was 39% getting worse from previous test Which is36%…

  • Carole Says:

    Hi Haratua,
    A Cochrane review of a number of existing scientific studies found only weak evidence that use of antioxidant supplements improved sperm quality and called for more, better studies to determine whether taking antioxidant supplements improves sperm quality. Link to article here:http://www.ncbi.nlm.nih.gov/pubmed/25504418. The full paper along with a “plain language summary” can be found here http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007411.pub3/abstract;jsessionid=61E03CE3B63C19C9C18BD82E6441FB00.f03t02
    Based on this, you should be cautious in using any supplements that you have not discussed with your doctor. Supplements are not as well studied or as well-regulated as prescription drugs, and although they are great for generating large profits for supplement-manufacturers, they often don’t work or cause side-effects when taken with other medications. A better approach might be to try to identify factors in your life that are harmful to sperm (toxic/harmful items you may be exposed to at work or at home- high heat environments, toxic chemicals, solvents, pesticides, side effects from some prescribed drugs or recreational drugs) and remove them as much as possible. I would discuss these issues with a urologist who specializes in male infertility. Good Luck!! Carole

  • Sarah Says:

    Hi Carole, could the difference way that the eggs and sperm are handled between ivf and icsi (e.g.) mediums mean that sperm DNA fragmentation has less of an effect in icsi? For example that the ivf process damages sperm? Sarah

  • Carole Says:

    Hi Sarah,
    I think it is unlikely that sperm processing damages sperm because the same processes are used for all kinds of interventions (IUI, IVF amd ICSI) and very good fertilization rates can be obtained. DNA fragmentation may be more likely due to DNA stability issues or exposure to toxins, radioactivity etc. that could break the DNA/chromosomes down. Carole

  • sarvan Says:

    hi am barsarvan am having 35 percent sperm DNA Fragmentation shall i try IUI Treatment for pregnancy

  • sarvan Says:

    hi am sarvan am having 35 percent DNA fragmentation and 73 million count per ml and 20 pecent motility and 50 percent morpology what kind of tratment need to pregnant my wife

  • Carole Says:

    Hi Sarvan,
    Greater than 30% DNA fragmentation is suggestive of poor fertility. I think you should see a urologist whose specialty is treating male infertility and see whether they can uncover a reason for the high DNA fragmentation (underlying medical condition in the testis; exposures to some chemicals) and perhaps recommend something to improve the quality of your sperm. There are some sperm selection tests (hyaluronan binding) that are used to pick sperm for ICSI that might be helpful in your case, if the % fragmentation can not be reduced. Good Luck!! Carole

  • sarvan Says:

    thank you carol
    in this case ICSI treatment will give positive result for pregnancy

  • sarvan Says:

    i check with urology he reffered IUI Treatment if i go IUI Treatment is possible otherwise i have to go ICSI PLEASE ADVISE ME

  • Carole Says:

    Hi Sarvan,
    I think you should follow your physician’s advice regarding the pros and cons of your treatment options. Generally speaking, IUI is less successful than ICSI if you have poor quality sperm. Good Luck!! Carole

  • Sara Says:

    Hi carol

    I am so glad I ran across your article.
    My husband had 0%morphology and low motility. IUI was not an option so we were advised to do ICSI. I went through the IVF cycle and egg retrieval was yesterday. They were able to preform ICSI on 10 of the retrieved eggs and 6 fertilized. However they told us that they had an extremely hard time finding normal sperm and although 7 did fertilize they aren’t sure they would be able to divide (they have a feeling the sperm has DNA issue). My question is can DNA fragmented sperm fertilize an egg? and divide successfully and result in a pregnancy? Isn’t 7 fertilized eggs a good number to eliminate the possible risk of DNA issue? My egg quality was excellent. My husband also has Varicocele but it isn’t extreme however if this fails then we will definitely get it repaired in the next couple months- in hopes that it changes his morphology.

  • Carole Says:

    Hi Sara,
    The 0% normal morphology is of concern because even though they did ICSI to bypass any possibly binding issues with abnormally shaped sperm; if the abnormal shape also correlates with sperm DNA issues (it might) , then it could make fertilization and embryo development less likely. Time will tell. Some sperm morphology issues are superficial and can be bypassed with ICSI; DNA fragmentation issues are not corrected by ICSI. I wish you all the best for a good outcome. Varicocele repair is a logical next step. Here is an abstract with a review of the literature- http://www.ncbi.nlm.nih.gov/pubmed/21196073 Varicocele repair can result in improvements in sperm quality. Good Luck!! Carole

  • Nathan Says:

    Hi Carole, lots of blessings from UK for this wonderful post. This is really helpful for many people across globe trying to find answers for DFI. Trust me! Here are my details: count 40 mill/ml, progressive motility: 50%, non progressive: 10%. Normal form morph: 60%; abnormal form morph: 40%. DFI: 24%. Ex smoker (stopped smoking 2 years ago). Prescribed evion forte capsules and asked to check DFI post 2 months. Asked to keep trying as well. Que: Does smoking effect reside in body though I havent smoked more than 750 days? I had high fever 3 months ago. I am eating good fruits (lots of oranges). I dont drink, wear loose clothing. Is this DFI fixable? Can a pregnancy caused from faulty DNA survive and produce healthy offspring? Oh, so many questions ! Awaiting your response. Thanks for the work you are doing. Peace !

  • Nathan Says:

    Correction in question above: I haven’t smoked in last ~750 days. Sorry for typo.

  • Carole Says:

    HI Nathan,
    Your overall parameters are normal and even your DFI (24%) is consistent with a reasonable probability of fertility- so I don’t think you are in terrible shape. We know that currently smoking is bad for sperm but I don’t think anyone has tried to correlate length of smoke-free period with sperm quality. Since it’s been at least 3 months since you stopped smoking, the current batch of sperm wouldn’t have been exposed to smoke directly. Sperm with DNA fragmentation tend not to create embryos at all. If you have a pregnancy, odds are that a better non-fragmented DNA containing sperm caused it. I think you are on the right track. Even in couples with completely normal parameters, it can take several months (up to a year is the rule of thumb) and still be considered fertile. Good luck!! Carole

  • serva Says:

    am having dfa 27 percent

  • sam Says:

    Hi Carole
    There are the following information
    please help me for a good fertility.
    DFI=26%
    normal morphology=2% head defects=97%
    abnormal morphology=98% Neck defects=39%
    concentration(Mill/ml)=20 Tail defects=14%
    Total count (Mill/Ejaculate)=90
    total motility=41
    progressive=30
    Non pogressive=11
    immotile=59

  • sam Says:

    I would be very thankful if you could anwer me and lead me to take a resonable decision.

  • Carole Says:

    HI Sam,
    You need to compare your lab values with the normal ranges for the test. I could guess what they are but they differ by lab. You should have the doctor who ordered this test go over both your numbers and the normal ranges with you and explain the clinical implications of your result. I would do you a disservice to try to make a guess from what you have shared. Good Luck!! Carole

  • Ellen Says:

    Hi Carol… God bless you for your articles. Me 39, husband 44 with dfi 40%. One miscarriege from my first cycle at 5th week. Just finished my 2nd cycle and had 20 eggs retrieved, 16 in good shape. Our doc begun with PICSI treatment but said that no sperm bound on the dish( is that possible?) so he proceeded with ICSI. 11 eggs fertilised. Now my concern is this…supposedly i get pregnant, when do you think i will be able to stop worrying of miscarrige because of the high dfi score? Is there a checkpoint where i could set myself free of worries because of this situation? Thank you so much for all these articles…

  • Carole Says:

    Hi Ellen,
    First, I would ask your clinic this question because they have experience with how past patients have done who have this issue. Most miscarriages happen before 13 weeks- regardless of cause- so I think you could breathe a little easier at that point. Here is an article about miscarriage that might be helpful: http://americanpregnancy.org/pregnancy-complications/miscarriage/ Please don’t be consumed with worry- it does not change the outcome- and only makes you miserable. Wishing you MUCH GOOD LUCK!! Carole

  • Sara Says:

    Hi Carol

    I posted here a few months ago and your suggested article gave me so much hope and relief. We were only able to freeze two day 2 cleavages. We are really hopeful that one might stick. The rest didn’t make it to blastocyte and were severely fragmented therefore unable to freeze. My question is can low morphology cause abnormality if an embryo sticks is low morphology associated with Down syndrome?
    Thank you again for this great website and for your valuable input.

  • Carole Says:

    Hi Sara,
    I think morphology can be independent of chromosomal issues- particularly the presence of an extra chromosome #21 which causes downs syndrome. We routinely grew embryos that were chromosomally abnormal into blastocyst stage to use for biopsy practice- with patient consent- and they often looked indistinquishable from their normal counterparts. Good Luck!! Carole

  • Dee Says:

    Hello, I’m so happy to find DNA fragmentation information finally. My husband has a DNA frag of 36%. Everything else checks out good. Count, motility, morphology and so on. He was put on coast science male fertilty pills to help bring the fragmentation down.
    Since starting with our RE, we have tried cycle monitoring with timed intercourse, each time having at least 2 mature follicules at time of trigger, had iui done. All resulted in a negative test.
    We now are moving towards ivf with icsi. We were told to do the embryo testing, but we just can’t afford the costs of all of this.
    We have been trying very hard for over a year, I am very regular and have good eggs. Starting to lose hope that we will ever have a baby together.
    Is there any advice you can give me that my RE hasn’t already? I’m on clomid, ovidrel injections, progesterone to help support a pregnacy if we do get one that implants. I’m taking q10 and prenatal vitamin too. I’m looking for anything that can help. Thanks in advance!

  • Carole Says:

    HI Dee,
    Sperm DNA fragmentation is a tough barrier to conception. Here is an interesting discussion on this topic: http://www.sciencedirect.com/science/article/pii/S1110569013000137
    If you are using ICSI, you should ask your doctor about the use of HBA-binding to select sperm for ICSI. http://www.ivf1.com/hyaluronan-binding-assay/ There is research data to suggest that being able to bind to hyalurionan is correlated with good sperm DNA integrity- and thus better fertilization and pregnancy rates. More about this topic in general can be found here: http://fertilitylabinsider.com/2011/06/wishing-for-a-happy-fathers-day/ Good Luck!!! Dee

  • Sam Says:

    Hi Carole,
    Thank you for active responses in this forum.

    We have been trying for past 4 years with 6 failed IUI and 3 failed ICSI. To give additional info on ICSI – in our first ICSI 3 fertilised with two Grada A on day 3 (6-8 cells division), for 2nd cycle only two fertilised with 1 grade A on day 3 and in our last cycle we have got 5 fertilised eggs 4 grade A hence decided to put 3 and freeze 2. All these attempts raised our hope but in vain. About me I have average sperm quality 15mill sperm with 35% morphology and 50% progressive.

    Its heartening to see so many failed attempts hence could you please comments if sperm quality is one of the reason for these failed cycles (presuming no issues with my wife) and in our next cycle should we try IMSI or do ICSI with blastocyst ET .

  • Carole Says:

    HI Sam,
    I am sorry you and your wife are having such a difficult time. IMSI is ICSI with sperm selection based on morphology- that might be helpful but your morphology is not terrible so that may not be the issue. Advanced Maternal age greater than 35 years of age, if applicable to your situation, is a frequent barrier to good embryo development because as eggs get older, they tend to have more chromosomal abnormalities. Sperm DNA fragmentation can also be a problem but if your morphology is pretty good, that is less likely. I am assuming that you have checked the pregnancy rates of your clinic–if publicly available where you live- and you are going to an “above average” clinic. A mediocre clinic can also explain your results. You might consider a second opinion if you are not going to the best clinic in your area. Good Luck! Carole

  • Sam Says:

    Dear Carole,

    Thank you for response.

    I forgot to mention that I am 38 and my wife is 37. Appreciate your comments on egg quality and DNA fragmentation. At this juncture we want to increase our chances so will do DNA fragmentation to rule out this possibility.

    We did change the clinic and last cycle was with a clinic which has good success rate.

    Thank you for your time and advice

  • April Says:

    Hello,

    My Husband and I had 3 consecutive miscarriages and I did all the tests it came back all normal… However, my husband had to undergo some sperm analysis and here are the results:

    Concentration (M/ml) 121.20

    Motility (% rapid) 14.28

    Motility (% rapid + slow) 32.21

    SCSA Score (% DFI) 37.6%

    Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) 42%

  • April Says:

    Hello,

    My Husband and I had 3 consecutive miscarriages and I did all the tests it came back all normal… However, my husband had to undergo some sperm analysis and here are the results:

    Concentration (M/ml) 121.20

    Motility (% rapid) 14.28

    Motility (% rapid + slow) 32.21

    SCSA Score (% DFI) 37.6%

    Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) 42%

    What do you think should be our option to conceive?

    PS: I have been able to fall pregnant from the 1st try each time I got pregnant… and I lost the baby between 7-9 weeks….

    do you think I should do IUI or IVF with ICSI???

  • Carole Says:

    Hi April,I would follow up with a male infertility specialist. The % fragmented DNA in the sperm is concerning. There may be some underlying reason for this so a consult with a male infertility specialist could be useful to get a proper diagnostic work up and history to identify any possible causes that could be corrected. Most IVF specialists focus on the female issues and when there is a sperm problem, their only answer is ICSI which is not helpful unless it is combined with a method to find normal sperm with intact DNA. There is some evidence that PICSI might be helpful in identifying more mature sperm but not sure it is necessarily helpful for fragmentation. That’s why seeking a consult from a board certified urologist specializing in male infertility is probably a good next step before you dive into ICSI. Good Luck!!!

  • Clay Says:

    Hi Carole,

    I have enjoyed reading your website. Other than academic papers, there isn’t a lot of information regarding DNA fragmentation. Thank you for this!

    After three unsuccessful IUI attempts, I had an advanced semen analysis performed 2 years ago: DFI 47%, OSA 4.7 uM and HDS 11%. No indications of fertility issues with my wife. We tried ICSI in October 2014 and had two embryos transferred resulting in our miracle baby girl delivered in July 2015. I can’t recall the exact numbers but our initial fertilization was very positive but unfortunately there were no viable embryos to freeze. I was diagnosed with not one but two varicoceles! Wanting to give it a go the natural way, I had the varicoceles successfully repaired in December 2015. I just had a follow up advanced semen analysis performed: DFI 58%, OSA 4.7 uM and HDS 12%. My results were actually worse and I’m devastated. I’m worried that our first try at ICSI was really really a miracle and trying again and not being successful would be even more devastating. The lab report says predicted success for standard IVF is normal and ICSI is normal. Is that true?

    Thank you!

  • Carole Says:

    HI Clay,
    Can you get the name and contact information of the lab director of the sperm lab that ran your DFI test? The lab director should be able to explain the basis of the predicted clinical outcome relative to the % DFI. That’s the best way to get the answers you need. When I wrote this post several years go, I referenced a paper which suggested poor outcomes with patients whose DFI was greater than 30%. More time to study more patients might have changed the recommendation. Please follow up with your lab. They will most likely be willing to talk with you. Good Luck!! Carole

  • David W Says:

    Hi Carole,

    I have always had concerns about my DFI. Last month my wife and I had our first try at a clinic. 25 eggs were retrieved. 13 were used for ICSI and 12 were used for conventional IVF. On the ICIS side, we got 5 blastocysts all with 5AA grading. On the conventional IVF side, we only got one blastocyst, also with 5AA grading. We only want to have one baby at a time. Should we use the one and only blastocyst from conventional IVF or should we pick one from the ICSI side?

    David

Join the discussion