The role of sperm DNA fragmentation testing in predicting IVF and PGT-A outcomes

This retrospective study evaluated whether sperm DNA fragmentation (SDF), measured by DNA fragmentation index (DFI), predicts IVF outcomes in 124 couples undergoing IVF with PGT-A (Preimplantation Genetic Testing for Aneuploidy) between 2015 and 2023. SDF was assessed using the Halosperm kit and categorized into low (≤ 15%, n = 81), medium (15-30%, n = 34), and high (≥ 30%, n = 9) DFI groups. Fertilization was performed via IVF or ICSI, and embryos were analyzed with PGT-A using next-generation sequencing. High DFI was associated with advanced paternal age, reduced motility, lower fertilization rates (in ICSI), and fewer good-quality blastocysts. However, PGT-A outcomes showed no significant differences in euploidy, mosaicism, or aneuploidy rates across DFI groups. Similarly, despite the methodological limitations of a retrospective design and a highly selected cohort, implantation, pregnancy, and live birth rates following euploid embryo transfer were unaffected by DFI level. SDF testing can help identify male infertility factors and guide IVF strategy, particularly regarding sperm selection. These findings suggest that early developmental impairment from sperm DNA damage may possibly be mitigated by embryonic repair mechanisms at later stages.