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. 2020 Dec;47(4):277-283.
doi: 10.5653/cerm.2020.03860. Epub 2020 Nov 20.

Sperm chromatin structure assay versus sperm chromatin dispersion kits: Technical repeatability and choice of assisted reproductive technology procedure

Affiliations

Sperm chromatin structure assay versus sperm chromatin dispersion kits: Technical repeatability and choice of assisted reproductive technology procedure

Vidya Laxme B et al. Clin Exp Reprod Med. 2020 Dec.

Abstract

Objective: The sperm DNA fragmentation index (DFI) guides the clinician's choice of an appropriate assisted reproductive technology (ART) procedure. The DFI can be determined using commercially available methodologies, including sperm chromatin dispersion (SCD) kits and sperm chromatin structure assay (SCSA). Currently, when DFI is evaluated using SCD kits, the result is analyzed in reference to the SCSA-derived threshold for the choice of an ART procedure. In this study, we compared DFI values obtained using SCSA with those obtained using SCD and determined whether the difference affects the choice of ART procedure.

Methods: We compared SCSA to two SCD kits, CANfrag (n=36) and Halosperm (n=31), to assess the DFI values obtained, the correlations between tests, the technical repeatability, and the impact of DFI on the choice of ART.

Results: We obtained higher median DFI values using SCD kits than when using SCSA, and this difference was significant for the CANfrag kit (p<0.001). The SCD kits had significantly higher coefficients of variation than SCSA (p<0.001). In vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) would be chosen for a significantly higher proportion of patients if a decision were made based on DFI derived from SCD rather than DFI determined using SCSA (p=0.003).

Conclusion: Our results indicate that SCD kit-specific thresholds should be established in order to avoid the unnecessary use of IVF/ICSI based on sperm DNA damage for the management of infertility. Appropriate measures should be taken to mitigate the increased variability inherent to the methods used in these tests.

Keywords: Assisted reproductive technology; DNA fragmentation; Male infertility; Sperm.

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Conflict of interest statement

Conflict of interest

Vidya Laxme B, Silviya Stephen, Ramyashree Devaraj, and Tara Mahendran are employees of the Andrology Center in Coimbatore, India. No other potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Flowchart of study design. A total of 41 patients were enrolled in the study, all of whom were assessed via sperm chromatin structure assay (SCSA). Subsets of patients were also compared using CANfrag (n=36) or Halosperm (n=31) sperm chromatin dispersion kits as indicated. The DNA fragmentation index (DFI), correlation, % coefficient of variation (CV), and impact of the derived DFI on the clinical decision were assessed.
Figure 2.
Figure 2.
Lower DNA fragmentation index (DFI) values obtained with sperm chromatin structure assay (SCSA) than with sperm chromatin dispersion (SCD) kits. The graph indicates the DFI with the line within the box set at the median in 29 semen samples analyzed using SCSA (median DFI, 19.3%), Halosperm (median DFI, 24.7%) or CANfrag (median DFI, 29%). The DFI of SCSA and Halosperm was significantly lower than CANfrag. a)p<0.001, Statistically.
Figure 3.
Figure 3.
Technical repeatability of the test. The graph indicates the mean DNA fragmentation index (DFI; black line) and the 95% confidence interval (green, upper limit; red, lower limit) of the different tests. (A) Sperm chromatin structure assay (SCSA). (B) Halosperm. (C) CANfrag.
Figure 4.
Figure 4.
(A) Differences in categorizing sperm potential. A heat map of 29 patients with the representative DNA fragmentation index (DFI) for a patient when sperm chromatin structure assay (SCSA), Halosperm, or CANfrag were used. The color-coding represents the categories of sperm potential established for SCSA (green, <15% DFI, indicating excellent fertility potential; yellow, 15%–25% DFI, indicating good to fair fertility potential; orange, >25%–50% DFI, indicating fair to poor fertility potential; red, >50% DFI, indicating very poor integrity). (B) Clinical management is affected by the type of assay utilized to measure the DFI. The bars provide a visual representation of the number of patients selected for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI; in red) or in vivo/intrauterine fertilization (in vivo/IUI) when SCSA, Halosperm, or CANfrag kits were used. The chi-square test revealed a statistically significant difference in the type of assisted reproductive technology (ART) procedure chosen based on the assay (p=0.003). SCD, sperm chromatin dispersion. a)Statistically significant.

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