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Objective: To study the implications of sperm DNA fragmentation (SDF) in intracytoplasmic sperm injection cycles for non-male factor infertility. Design: Prospective cohort study. Setting: Private university-affiliated IVF center. Patient(s): Data from 475 cycles performed from June 2016 to June 2017. Intervention(s): Cycles were divided according to SDF rate into two groups: <30% SDF (n ¼ 433) and R30% SDF (n ¼ 42). Laboratory and clinical outcomes were compared between groups by generalized linear models adjusted for potential confounders. Main Outcome Measure(s): Embryo quality and miscarriage rates. Result(s): Fertilization rate was similar between groups (R30% SDF, 85.28% AE 1.06% vs. <30% SDF, 90.68% AE 3.61%). Significantly lower rates of normal cleavage speed (R30% SDF, 61.12% AE 4.21% vs. <30% SDF, 72.53% AE 1.24%), high-quality embryos at day 3 (R30% SDF, 23.07% AE 5.56% vs. <30% SDF, 36.41% AE 1.53%), blastocyst formation (R30% SDF, 39.09% AE 2.73% vs. <30% SDF, 58.83% AE 7.59%), blastocyst quality (R30% SDF, 11.97% AE 1.22% vs. <30% SDF, 30.09% AE 2.39%), and implantation (33.24% AE 1.66% vs. <30% SDF, 46.40% AE 4.61%) were observed in cycles with higher SDF, despite similar pregnancy rates (R30% SDF, 30.40% vs. <30% SDF, 32.40%). A 2.5-fold miscarriage rate was observed in cycles with an SDF above the established cutoff (R30% SDF, 42.8% vs. <30% SDF, 16.8%). Conclusion(s):Higher SDF is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in nonmale factor infertility intracytoplasmic sperm injection cycles. Since defects in sperm may be hidden, the SDF test can bring additional information to the sperm quality evaluation of men with unknown infertility history. (Fertil Steril Ò 2019;112:483-90. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

The objective of this study was to compare (i) the intracytoplasmic sperm injection outcomes among groups with different total motile sperm count ranges, (ii) the intracytoplasmic sperm injection outcomes between groups with normal and abnormal total motile sperm count, and (iii) the predictive values of WHO 2010 cut-off values and pre-wash total motile sperm count for the intracytoplasmic sperm injection outcomes, in couples with male infertility. This study included data from 518 patients undergoing their first intracytoplasmic sperm injection cycle as a result of male infertility. Couples were divided into five groups according to their total motile sperm count: Group I, total motile sperm count <1 × 10(6) ; group II, total motile sperm count 1-5 × 10(6) ; group III, total motile sperm count 5-10 × 10(6) ; group IV, total motile sperm count 10-20 × 10(6) ; and group V, total motile sperm count >20 × 10(6) (which was considered a normal total motile sperm count value). Then, couples were grouped into an abnormal and normal total motile sperm count group. The groups were compared regarding intracytoplasmic sperm injection outcomes. The predictive values of WHO 2010 cut-off values and total motile sperm count for the intracytoplasmic sperm injection outcomes were also investigated. The fertilization rate was lower in total motile sperm count group I compared to total motile sperm count group V (72.5 ± 17.6 vs. 84.9 ± 14.4, p = 0.011). The normal total motile sperm count group had a higher fertilization rate (84.9 ± 14.4 vs. 81.1 ± 15.8, p = 0.016) and lower miscarriage rate (17.9% vs. 29.5%, p = 0.041) compared to the abnormal total motile sperm count group. The total motile sperm count was the only parameter that demonstrated a predictive value for the formation of high-quality embryos on D2 (OR: 1.18, p = 0.013), formation of high-quality embryos on D3 (OR: 1.12, p = 0.037), formation of blastocysts on D5 (OR: 1.16, p = 0.011), blastocyst expansion grade on D5 (OR: 1.27, p = 0.042), and the odds of miscarriage (OR: 0.52, p < 0.045). The total motile sperm count has a greater predictive value than the WHO 2010 cut-off values for laboratory results and pregnancy outcomes in couples undergoing intracytoplasmic sperm injection as a result of male infertility.