Relationship of Sperm DNA Fragmentation Index and Pregnancy Rates in ICSI Cycles for Iraqi Fertility Centres

Author(s): 1Zahraa Abdulsalam Hussein ,2Sarah sameer saadoon, 3Sameerah saadoon Mustafa
Date: 09/10/2026
doi: https://doi.org/10.5281/zenodo.8425890

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Abstract

Background: Sperm DNA fragmentation (SDF) is becoming a vital component in how we think about 
male infertility and the treatment using assisted reproductive technology (ART). The objective of the study 
was to evaluate the relationship between sperm DNA fragmentation index (DFI) and pregnancy rates in 
intracytoplasmic sperm injection (ICSI) cycles at Iraqi fertility centres . 
Methods: A prospective cohort design study was performed across three private fertility centres in 
Baghdad, Iraq, between January 2022 to December 2023. In total, 485 ICSI cycles were included in the 
analyses; sperm DFI was measured using the sperm chromatin structure assay (SCSA). Patients were 
broken down into low (≤15%), moderate (16-30%) and high (>30%) DFI . 
Results: The clinical pregnancy rate was significantly higher in the low DFI (62.8%) group when 
compared to both the moderate (41.2%) and high (24.6%) DFI groups (p<0.001). The live birth rate was 
reflected similarly in each group (54.3%, 33.7%, and 18.5% respectively). Multiple regression analysis 
indicated DFI as an independent predictor of pregnancy . 
Conclusion: Sperm DNA fragmentation index was found to inversely correlate with pregnancy rates in 
ICSI cycles. Routine implementation of DFI testing in fertility practice in Iraq may improve results and 
offer better advice to patients.

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