The Impact of Sperm DNA Fragmentation on Intrauterine Insemination Outcomes and Intervention Strategies

doi:10.12280/gjszjk.20250375

Abstract

Abstract:

Intrauterine insemination (IUI) has become a first-line method of assisted reproduction, due to its simple operation and low cost. However, the success rate of IUI has been stagnant at 10%-15% for many years. Sperm DNA fragmentation (SDF) is an important indicator for evaluating sperm function, and its formation mechanism involves endogenous factors (such as oxidative stress, abnormal apoptosis, and abnormal chromatin remodeling) and exogenous factors (such as environment, lifestyle, and iatrogenic influences). The common SDF detection methods pose challenges to the interpretation of detection results due to their inconsistent critical values. The elevated SDF rate has a significant impact on IUI outcomes, including reduced fertilization rates, pregnancy rates, and increased the risk of adverse pregnancy outcomes. At present, the intervention strategies for high SDF rate include lifestyle adjustments, medication or surgical treatment, and rational selection of assisted reproductive technologies. Clinical recommendations include SDF testing for couples with repeated IUI failures or unexplained infertility, and individualized comprehensive treatment strategies to improve fertility outcomes.

Key words: Spermatozoa, DNA fragmentation, Insemination, artificial, Infertility, male, Reproductive techniques, assisted, Pregnancy outcome

CHEN Jia-lang, ZHANG Yun-shan, WANG Guang-teng, PANG Ze-hui. The Impact of Sperm DNA Fragmentation on Intrauterine Insemination Outcomes and Intervention Strategies[J]. Journal of International Reproductive Health/Family Planning, 2026, 45(1): 40-44.

Figures/Tables 1

References 39

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检测方法	简述	核心优势	主要局限性
SCD	完整DNA在特定实验条件下，染色质扩散形成“光环”，而损伤精子无光环或光环不完整^[15]；阈值*为17.0％~27.3%^[16]	操作较简单；成本较低；易于推广	无法区分SSB/DSB；结果判读主观性较强^[17]
TUNEL	末端转移酶（terminal deoxynucleotidyl transferase，TdT）将荧光标记dUTP连接到DNA断裂末端（3'-OH）^[17]；阈值为4％~20%^[16]	敏感度高（可达96%）^[18]；能区分SSB/DSB^[18]	需流式细胞仪等昂贵设备^[17]；样本固定可能影响DNA结构
SCSA	吖啶橙染色：变性后单链DNA发红光，双链DNA发绿光，流式细胞仪检测红绿荧光比计算DFI^[19]；阈值为11.3％~30.3%^[16]	自动化程度高；标准化好；重复性佳	反映染色质稳定性，不是直接检测DNA链断裂
彗星试验	细胞裂解后电泳：在碱性条件下电泳，受损DNA片段向阳极迁移形成“彗尾”，尾长等参数反映损伤程度^[20]；阈值为44％~56%^[16]	可检测少量精子细胞的DNA损伤	操作复杂，条件控制严格；标准化困难，重现性受多因素影响

检测方法	简述	核心优势	主要局限性
SCD	完整DNA在特定实验条件下，染色质扩散形成“光环”，而损伤精子无光环或光环不完整^[15]；阈值*为17.0％~27.3%^[16]	操作较简单；成本较低；易于推广	无法区分SSB/DSB；结果判读主观性较强^[17]
TUNEL	末端转移酶（terminal deoxynucleotidyl transferase，TdT）将荧光标记dUTP连接到DNA断裂末端（3'-OH）^[17]；阈值为4％~20%^[16]	敏感度高（可达96%）^[18]；能区分SSB/DSB^[18]	需流式细胞仪等昂贵设备^[17]；样本固定可能影响DNA结构
SCSA	吖啶橙染色：变性后单链DNA发红光，双链DNA发绿光，流式细胞仪检测红绿荧光比计算DFI^[19]；阈值为11.3％~30.3%^[16]	自动化程度高；标准化好；重复性佳	反映染色质稳定性，不是直接检测DNA链断裂
彗星试验	细胞裂解后电泳：在碱性条件下电泳，受损DNA片段向阳极迁移形成“彗尾”，尾长等参数反映损伤程度^[20]；阈值为44％~56%^[16]	可检测少量精子细胞的DNA损伤	操作复杂，条件控制严格；标准化困难，重现性受多因素影响