Diagnostic accuracy of sperm DNA fragmentation index in male infertility: A cohort study

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Background: To explore the correlation of sperm DNA fragmentation index (DFI) with semen quality, while assessing the diagnostic potential of DFI in male infertility, aiming to offer a novel biomarker and clinical approach for male fertility evaluation. Methods: A cohort of 613 men who visited our hospital between April 2023 and February 2025 was included in this study. Semen analysis (assessing concentration, motility, morphology, etc.) and sperm chromatin dispersion testing were conducted to determine DFI. The diagnostic performance of DFI for infertility was evaluated using receiver operating characteristic (ROC) curve analysis. Subgroup analyses (oligozoospermia, asthenozoospermia, and oligoasthenozoospermia) were conducted to assess the discriminative power of DFI. After treatment, the patients were followed up for 1 year, and the predictive effect of DFI on the prognosis of successful fertility was analysed. Results: Among infertile men (n = 92, incidence rate: 15.01%), DFI levels were significantly elevated compared to those with normal fertility (P< 0.05). ROC curve analysis demonstrated that DFI had a sensitivity of 60.87% and specificity of 84.07% (AUC= 0.774) in diagnosing infertility. Notably, DFI displayed the highest discriminative efficacy for oligoasthenozoospermia (AUC= 0.825). Finally, the sensitivity and specificity of DFI for predicting successful fertility in infertile men at 1 year were 83.08% and 62.96%, respectively (P< 0.001). Conclusions: DFI demonstrates high diagnostic accuracy on the fertility of infertile men and has a high clinical potential.

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