P-105 The Reliability of Sperm Chromatin Dispersion (SCD) Test to Predict Assisted Reproductive Technology (ART) Treatments Outcomes -A Systematic Review and Meta-Analysis
Authors: Sawaid kaiyal R , Kumar Karna K , Cannarella R , Shinnosuke K , Scott L , Vij S C 
Published: June 2023

Abstract

Study question
Is the sperm chromatin dispersion (SCD) test reliable for predicting reproductive technology (ART) treatment outcomes?

Summary answer
Assessment of DNA fragmentation using the SCD test failed to predict pregnancy or live births rates.

What is known already
The detrimental effect of high DNA fragmentation on semen quality, fertility, and poor ART outcomes has been well-studied in recent years. Still, it remains contentious. Several techniques can detect sperm DNA fragmentation, such as TUNEL, comet assay, and SCSA. Although these techniques have been implemented in many andrology laboratories, they remain complex, time-consuming, and expensive. On the other hand, the SCD test indirectly estimates the DNA fragmentation level by manually quantifying the number of halos representing nuclear dispersion after sperm lysis and acid denaturation. While the SCD test is commonly used, it remains subjected to bias and high variability.

Study design, size, duration
Systematic review and meta-analysis.
A PRISMA-guided literature search in the English language was performed in January 2021 using PubMed/MEDLINE, Scopus, and Google scholar.
We looked for rates of fertilization, cleavage rate embryos, implantation, clinical pregnancy, miscarriage, and live birth.
MedCalc software using the random effects model was used, Sensitivity analysis was conducted to examine heterogeneity and the robustness of the results.

Participants/materials, setting, methods
After duplicate removal, 179 abstracts were assessed for eligibility, and 55 full-text articles were screened. Forty-one articles were included in the qualitative syntheses, and 16 were included in the quantitative synthesis, representing 6989 participants.

Main results and the role of chance
No significant difference was identified between the group with high SDF vs. low SDF regarding fertilization (SMD −0.334, 95% CI −0.695, 0.027, p = 0.07), clinical pregnancy (OR 0.901, 95% CI 0.719, 1.130, p = 0.367), miscarriage (OR 0.901, 95% CI 0.719, 1.130, p = 0.367) and live birth (OR 1.105, 95% CI 0.627, 1.946, p = 0.730) rates.
The rates of cleavage stage embryos (SMD -1.153, 95% CI -2.113, −0.194, p = 0.019) and implantation (OR 0.472, 95% CI 0.303, 0.737, p = 0.001) were significantly lower in the group with high SDF vs. low SDF.

Limitations, reasons for caution
A high index of heterogeneity and publication bias was reported regarding fertilization (I2  =  93.23%, Egger’s test: intercept -5.29866, 95% CI -10.41, −0.19, p = 0.02) and cleavage-stage embryos(I2  =  98.49%, Egger’s test: intercept -14.02395, 95% CI -27.47, −0.57, p = 0.02)

Wider implications of the findings
Assessment of DNA fragmentation using the SCD test failed to predict pregnancy or live births. As the goal of ART is live birth, clinicians should consider the limited yield of this assay to predict the likelihood of live birth.

Trial registration number
NA