Abstract：
OBJECTIVE: To investigate the distribution of sperm DNA fragmentation (SDF) values and their association with clinical and seminal parameters in idiopathic infertile men.
METHODS: Data from 3224 primary infertile men (belonging to couples having failed to conceive a pregnancy within 12 months) who underwent a thorough diagnostic work-up were analysed. A SDF value ≥ 30% (according to Sperm Chromatin Structure Assay) was considered pathologic. We excluded: (1) men with genetic abnormalities; (2) men with history of cryptorchidism; (3) men with biochemical hypogonadism; (4) men with clinical varicocele; and (5) men with other possible known aetiological factors. Descriptive statistics and logistic regression analyses were used to describe the whole cohort.
RESULTS: Of all, 792 (23%) men with at least one abnormal WHO semen parameter but without any identified aetiologic factor for infertility, were considered as idiopathic infertile men. Of 792, 418 (52.7%) men had SDF ≥30%. Men with pathologic SDF were older (p = .02), had higher Follicle-stimulating hormone (FSH) (p = .04) but lower total testosterone (p = .03) values than those with SDF <30%. The homoeostatic model assessment index for insulin resistance (HOMA-IR) was higher in men with SDF ≥30% (p = .01). Idiopathic infertile men with SDF ≥30% presented with lower sperm concentration (p < .001) and lower progressive sperm motility (p < .01) than those with SDF < 30%. Logistic regression analysis revealed that older age (OR: 1.1, p = .02) and higher HOMA-IR score (OR: 1.8, p = .03) were associated with SDF ≥ 30%, after accounting for FSH and sperm concentration values.
CONCLUSIONS: Approximately half of infertile men categorized as idiopathic had pathologic SDF values. Idiopathic infertile men with pathologic SDF showed worse clinical, hormonal and semen parameters than those with normal SDF values. These results suggest that including SDF testing could be clinically relevant over the real-life management work-up of infertile men.
METHODS: Data from 3224 primary infertile men (belonging to couples having failed to conceive a pregnancy within 12 months) who underwent a thorough diagnostic work-up were analysed. A SDF value ≥ 30% (according to Sperm Chromatin Structure Assay) was considered pathologic. We excluded: (1) men with genetic abnormalities; (2) men with history of cryptorchidism; (3) men with biochemical hypogonadism; (4) men with clinical varicocele; and (5) men with other possible known aetiological factors. Descriptive statistics and logistic regression analyses were used to describe the whole cohort.
RESULTS: Of all, 792 (23%) men with at least one abnormal WHO semen parameter but without any identified aetiologic factor for infertility, were considered as idiopathic infertile men. Of 792, 418 (52.7%) men had SDF ≥30%. Men with pathologic SDF were older (p = .02), had higher Follicle-stimulating hormone (FSH) (p = .04) but lower total testosterone (p = .03) values than those with SDF <30%. The homoeostatic model assessment index for insulin resistance (HOMA-IR) was higher in men with SDF ≥30% (p = .01). Idiopathic infertile men with SDF ≥30% presented with lower sperm concentration (p < .001) and lower progressive sperm motility (p < .01) than those with SDF < 30%. Logistic regression analysis revealed that older age (OR: 1.1, p = .02) and higher HOMA-IR score (OR: 1.8, p = .03) were associated with SDF ≥ 30%, after accounting for FSH and sperm concentration values.
CONCLUSIONS: Approximately half of infertile men categorized as idiopathic had pathologic SDF values. Idiopathic infertile men with pathologic SDF showed worse clinical, hormonal and semen parameters than those with normal SDF values. These results suggest that including SDF testing could be clinically relevant over the real-life management work-up of infertile men.
摘要：
目的：探讨男性特发性不育患者精子DNA碎片（SDF）值的分布及其与临床和精液参数的关系。
方法：分析了3224名原发性不育男性（属于在12个月内未能怀孕的夫妇）的数据，他们接受了彻底的诊断检查。SDF值≥30%(根据精子染色质结构测定)被认为是病理性的。我们排除：（1）遗传异常的男性；（2）有隐睾病史的男性；（3）生化性腺功能减退症的男性；（4）临床精索静脉曲张的男性；（5）具有其他可能的病因的男性。描述性统计和逻辑回归分析用于描述整个队列。
结果：792名（23％）男性，至少有一个WHO精液参数异常，但没有任何明确的不育病因。被认为是特发性不育男性。在792人中，418名（52.7%）男性SDF≥30%。患有病理性SDF的男性年龄较大（p=0.02），与SDF<30％的患者相比，具有较高的促卵泡激素（FSH）（p=.04），但总睾丸激素（p=.03）值较低。在SDF≥30％的男性中，胰岛素抵抗的稳态模型评估指数（HOMA-IR）更高（p=0.01）。与SDF<30％的男性相比，SDF≥30％的特发性不育男性的精子浓度较低（p<.001）和进行性精子运动性较低（p<.01）。Logistic回归分析显示年龄较大(OR:1.1,p=.02)和HOMA-IR评分较高(OR:1.8,p=.03)与SDF≥30%相关。后考虑FSH和精子浓度值。
结论：大约一半的特发性不育男性具有病理性SDF值。病理性SDF的特发性不育男性临床表现较差，激素和精液参数比那些与正常的SDF值。这些结果表明，包括SDF测试可能与不育男性的现实生活管理工作有关。
方法：分析了3224名原发性不育男性（属于在12个月内未能怀孕的夫妇）的数据，他们接受了彻底的诊断检查。SDF值≥30%(根据精子染色质结构测定)被认为是病理性的。我们排除：（1）遗传异常的男性；（2）有隐睾病史的男性；（3）生化性腺功能减退症的男性；（4）临床精索静脉曲张的男性；（5）具有其他可能的病因的男性。描述性统计和逻辑回归分析用于描述整个队列。
结果：792名（23％）男性，至少有一个WHO精液参数异常，但没有任何明确的不育病因。被认为是特发性不育男性。在792人中，418名（52.7%）男性SDF≥30%。患有病理性SDF的男性年龄较大（p=0.02），与SDF<30％的患者相比，具有较高的促卵泡激素（FSH）（p=.04），但总睾丸激素（p=.03）值较低。在SDF≥30％的男性中，胰岛素抵抗的稳态模型评估指数（HOMA-IR）更高（p=0.01）。与SDF<30％的男性相比，SDF≥30％的特发性不育男性的精子浓度较低（p<.001）和进行性精子运动性较低（p<.01）。Logistic回归分析显示年龄较大(OR:1.1,p=.02)和HOMA-IR评分较高(OR:1.8,p=.03)与SDF≥30%相关。后考虑FSH和精子浓度值。
结论：大约一半的特发性不育男性具有病理性SDF值。病理性SDF的特发性不育男性临床表现较差，激素和精液参数比那些与正常的SDF值。这些结果表明，包括SDF测试可能与不育男性的现实生活管理工作有关。
