JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):38
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263565

P-26. Association between Sperm DNA Fragmentation and Recurrent Pregnancy Loss: Systematic Review

Ana Elisa Vasconcelos Gavião¹, Sofia Pontas Ananias¹, Luciana Morado Abbud¹, Ana Marcia de Miranda Cota¹

¹Faculdade Ciencias Medicas de Minas Gerais - Belo Horizonte - Minas Gerais - Brasil

Objective: This systematic review aims to analyze current evidence on the association between sperm DNA fragmentation (SDF) and recurrent pregnancy loss (RPL), considering both clinical and biological aspects based on the studies reviewed.
Methods: A systematic search was conducted in the PubMed and PMC databases using the descriptors “sperm DNA fragmentation” and “recurrent pregnancy loss.” Studies published in English between 2015 and 2025 were included, while those with topics divergent from the central objective were excluded. After a thorough reading of the Abstract section of the remaining papers, four main studies were selected: Busnelli et al. (2023), McQueen et al. (2019), Solanki et al. (2024), and Zhu et al. (2020), which address topics ranging from pathophysiological mechanisms to the clinical implications of SDF in infertility and pregnancy outcomes.
Results: Initially, the multicenter case-control study by Busnelli et al. (2023) compared 74 men from couples with recurrent pregnancy loss (RPL) to 37 proven fertile men and 100 infertile men. The study demonstrated that the RPL group had higher levels of SDF, with 21 men showing an SDF index > 30%. In contrast, no individuals in the fertile control group reached this threshold. In addition, a multivariate regression analysis confirmed a significant association between high SDF and RPL, particularly when combined with reduced sperm vitality and motility. The meta-analysis by McQueen et al. (2019), involving 13 studies, showed that men from couples with RPL have a 10.26% higher percentage of SDF than men from fertile control groups, regardless of conventional spermatic parameters, such as vitality and motility; those were not considered during the sperm selection for the fragmentation measurement. All analysis also presented an odds ratio higher than 2 for an abnormal fragmentation test result Furthermore, the cross-sectional study by Solanki et al. (2024) investigated the role of SDF by comparing 35 men from couples with a RPL history and 35 men with at least one previous live birth. A logistic regression analysis showed that SDF levels were higher among men whose partners experienced recurrent pregnancy loss; however, there were no statistically significant differences between groups. Nonetheless, a higher proportion of men with a sperm fragmentation index >30% was found in the first group (54.2%), compared to the control group (25.7%). The study by Zhu et al. (2020) assessed the association in question through a retrospective observational study, in which the sperm DNA fragmentation index was calculated and compared between 461 men from couples with RPL and 411 men from couples undergoing in vitro fertilization due to female factors. In this scenario, it was found that severe SDF was present in 42.3% of the study group and in 13.1% of the control group, which also had 54,7% of its participants showing normal fragmentation levels, compared to 22.8%. of men with RPL. These data evidence that this particular sperm damage is associated with recurrent pregnancy loss.
Conclusion: Sperm DNA fragmentation has been consistently associated with recurrent pregnancy loss. Although assisted reproduction techniques may partially mitigate the effects of SDF, identifying and addressing the underlying causes of fragmentation should be considered an integral part of managing couples with a history of recurrent miscarriages. Moreover, it is fundamental to understand how other spermatic parameters could be associated with the DNA fragmentation as a cause of recurrent pregnancy loss. Further studies are needed to establish more standardized diagnostic protocols and to assess the real impact of interventions on long-term reproductive outcomes.