Sperm chromatin structure assay and classical semen parameters: systematic review

Area of Science:

• Reproductive Medicine
• Andrology
• Infertility Diagnostics

Background:

• Accurate diagnosis of male factor infertility is crucial for effective fertility treatment.
• Classical semen parameters (CSP) are standard but have limitations in predicting fertility outcomes.
• Sperm chromatin structure assay (SCSA) offers an alternative assessment of sperm DNA integrity.

Purpose of the Study:

• To compare the clinical validity of SCSA versus CSP in diagnosing male infertility.
• To evaluate these tests in various clinical scenarios: conception attempts, prolonged infertility, and intrauterine insemination (IUI).

Main Methods:

• Systematic literature review and meta-analysis of studies retrieved from PubMed.
• Keywords focused on sperm diagnostic tests for pregnancy across three clinical contexts.
• Analysis of post-test probabilities of male factor infertility following abnormal test results.

Main Results:

• For couples attempting conception, abnormal SCSA results yield a post-test probability of male infertility ranging from 15.7% to 54.5%, compared to 11.8%-24.5% for abnormal CSP.
• When male factor infertility prevalence is 50%, abnormal SCSA and CSP show similar post-test probabilities.
• In IUI cycles, SCSA demonstrates higher clinical validity than sperm morphology alone but is insufficient for routine inclusion in male infertility work-up.

Conclusions:

• SCSA and CSP exhibit comparable clinical validity in diagnosing male factor infertility, particularly in scenarios with a 50% pre-test probability.
• Current evidence does not support the routine use of SCSA in male infertility evaluations for couples undergoing IUI.
• Further research is needed to refine the role of SCSA in specific clinical infertility settings.