Association of Sperm DNA Fragmentation and Intracytoplasmic Sperm Injection Outcomes in an Age-adjusted Cohort: A Retrospective Cohort Study.

Background: Sperm DNA fragmentation index (DFI) is increasingly recognised as a critical parameter in male infertility assessment. However, its prognostic utility in assisted reproduction, particularly in intracytoplasmic sperm injection (ICSI) cycles, remains uncertain. Aim: This study aims to evaluate the association between sperm DFI and clinical outcomes following ICSI and to examine whether this relationship is independent of maternal age. Settings and Design: A multicentre retrospective cohort study across private fertility centres in India. Materials and Methods: A total of 688 couples undergoing ICSI were analysed. Subjects were categorised based on sperm DFI levels (≤15%, 15%-30% and >30%). Semen characteristics and pregnancy outcomes were compared across all DFI groups. Multivariate logistic regression was performed to adjust for female age. Statistical Analysis Used: Kruskal-Wallis test, Chi-square test, univariate and multivariate logistic regression analysis. Results: Higher DFI was associated with poorer semen parameters, including lower motility, concentration and morphology. There was no statistically significant association between DFI levels and biochemical pregnancy, clinical pregnancy, ongoing pregnancy or live birth rates in couples who conceived after ICSI. These findings remained consistent after adjusting for maternal and paternal age. Conclusions: Sperm DFI was related to semen quality but did not independently predict ICSI outcomes. While it may provide adjunctive information in selected cases, it is not a prognostic marker of ICSI success.