The Prediction of Sperm Chromatin Structure Assay (SCSA) Parameters for Outcomes of Intrauterine Insemination

Abstract Background: Many studies have assessed the association between sperm DNA fragmentation and outcomes of ART. But the published papers have not offered enough evidence about whether sperm DNA fragmentation tests could make suggestions to predict intrauterine insemination (IUI) outcomes. The aim of this study was to assess whether the sperm chromatin structure assay (SCSA) parameters, sperm DNA fragmentation index (DFI) and high DNA stainability (HDS), could be used as predictors for treatment outcomes in IUI program.Methods: A retrospective cohort study was conducted at a large reproductive medicine center. 1139 IUI cycles from 1139 couples were studied. The association of SCSA parameters with the clinical pregnancy and early pregnancy loss after IUI were analyzed. Results: Clinical pregnancy rate per cycle in DFI<15%, 15%≤DFI<30%, and DFI≥30% groups were 11.1%, 7.3%, and 8.9%, respectively, with no statistical differences between the groups (P=0.127). Pregnancy loss rate were 24.3%, 27.6%, and 14.3%, respectively, with no statistical differences (P=0.762). Clinical pregnancy rate per cycle in HDS≤15% and HDS>15% groups were 9.8% and 7.5%, respectively, with no significant difference (P=0.468), and the pregnancy loss rate were 26.2% and 0, respectively, and also no statistical difference (P=0.191). Multivariate logistic regression analysis showed a higher rate of clinical pregnancy in couples with a younger female (OR=0.90, 95% CI: 0.83-0.97, P=0.007), and in couples with a male who had higher sperm concentration after washing (OR=1.02, 95% CI: 1.00-1.04, P=0.035). A higher risk of pregnancy loss was observed with increased female age (OR= 1.43, 95% CI:1.09-1.89, P=0.010) and lower sperm concentration after washing (OR= 0.92, 95% CI: 0.84-0.99, P= 0.029). Conclusions: Sperm DFI and HDS were not significantly correlated with clinical pregnancy and pregnancy loss in cycles of IUI. Female age and motile sperm concentration had statistically significant effects on both clinical pregnancy and pregnancy loss after IUI treatment.