***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To correlate intracytoplasmic sperm injection ( ICSI ) fertilization with chromatin status assessed by the Diff-Quik procedure modified with a one-minute soak step , and to determine the association of chromatin status with in vitro fertilization ( IVF ) pregnancy .  STUDY DESIGN This was a retrospective study of 81 IVF patients .  Gradient-centrifuge washed sperm remaining after ICSI were fixed , stained by Diff-Quik , immersed in water for 1 minute , and analyzed under oil immersion light microscopy .  Sperm nuclear coloration ( types A-D ) , strict morphology , fertilization , and pregnancy status were determined . RESULTS Sperm with light purple staining ( type A ) were correlated ( R = 0.48 , p < 0.05 ) with ICSI fertilization . The intraassay and interassay coefficients of variation were 5.9 % and 4.1 % , respectively . Sperm strict normal morphology was correlated neither with ICSI fertilization ( R = 0.24 , p > 0.05 ) nor with type A sperm ( R = 0.35 , p > 0.05 ) . Sperm incubated in Fenton reagent that damaged DNA showed a time-dependent decrease in percent type A sperm . However , there was no correlation with IVF pregnancy status . CONCLUSION This retrospective study showed that the inclusion of a one-minute soak step post-Diff-Quik staining enhanced the detection of sperm chromatin abnormalities related to ICSI fertilization . Fenton reagent-treated sperm suggested that the staining patterns correlated with DNA damage . A large prospect i ve trial should be undertaken to confirm these findings OBJECTIVE To examine the effects of increased sperm DNA damage in relation to seminal oxidative stress in men with idiopathic and male factor infertility . Prospect i ve study . SETTING S Infertility clinic at a tertiary care academic institution . PATIENT(S ) Ninety-two infertile men with normal female partners . Sixteen fertile donors served as the control group . INTERVENTION(S ) St and ard semen analysis and assessment of levels of seminal oxidative stress . Assisted reproductive techniques in 33 of the 92 patients ( IUI [ n = 19 ] , IVF [ n = 10 ] , and intracytoplasmic sperm injection [ n = 4 ] ) . MAIN OUTCOME MEASURE(S ) Sperm DNA damage by sperm chromatin structure assay . Results were expressed as DNA fragmentation index . RESULT ( S ) Patients were classified as having either idiopathic ( n = 23 ) or male factor infertility ( n = 69 ) . Patients with idiopathic and male factor infertility had significantly higher DNA fragmentation index and oxidative stress compared with the case of fertile donors . A clinical pregnancy was achieved in 9 ( 27 % ) of 33 patients with assisted reproductive techniques . Significantly higher DNA fragmentation index and oxidative stress were found in men who failed to initiate a pregnancy after assisted reproductive techniques ( n = 24 ) , compared with the cases of those who succeeded and of the fertile donors . DNA fragmentation index was correlated positively with oxidative stress ( r = 0.27 ) , and negatively with fertilization ( r = -0.70 ) and embryo quality ( r = -0.70 ) . CONCLUSION ( S ) Sperm DNA damage is significantly increased in men with idiopathic and male factor infertility and in men who failed to initiate a pregnancy after assisted reproductive techniques . Such an increase may be related to high levels of seminal oxidative stress A prospect i ve study was performed to assess the impact of sperm DNA fragmentation on the outcome of IVF with own or donated oocytes . The study population included 178 couples ( 62 cycles of IVF , 116 of intracytoplasmic sperm injection ( ICSI ) ) with own ( n=77 ) and donor ( n=101 ) oocytes .  DNA fragmentation was evaluated by TdT ( terminal deoxynucleotidyl transferase)-mediated dUDP nick-end labelling assay . Correlation between DNA damage to oocyte fertilization , embryo quality and clinical pregnancy , implantation and miscarriage rates was evaluated . DNA fragmentation was not related to fertilization rates in either IVF ( r=0.08 ) or ICSI ( r=-0.04 ) cycles . DNA fragmentation was similar in patients with < 50 % embryo utilization rate compared with ≥50 % , in cancelled and in embryo transfer cycles and in miscarriages and in successful deliveries . Moreover , DNA fragmentation was similar in pregnant and non-pregnant women as well as in IVF with own or donor oocytes . In the multivariable analysis , the odds ratio of DNA after controlling by age was 1.0 . Using a 36 % sperm fragmentation threshold , results did not vary . It is concluded that DNA damage was not related to outcomes of IVF or ICSI with own or donor oocytes BACKGROUND The aim of this study was to assess the presence of DNA str and breaks and sperm cell morphology in men suffering from unexplained infertility , and to compare these results with normal fertile and oligozoospermic men . METHODS One fresh sperm sample from proven fertile sperm donors ( n=20 ) and from infertile men with oligozoospermia , ( < 20 x 10(6)/ml sperm cells ) ( n=74 ) , and men suffering from unexplained infertility ( > 20 x 10(6)/ml sperm cells ) ( n=39 ) who delivered two sperm sample s with 24 hours interval  , were tested for the presence of DNA str and breaks in the spermatozoa by direct immunoperoxidase detection of digoxigenin-labeled genomic DNA . Correlations to other sperm parameters , sperm cell counts , motility , activation and Krüger 's strict criteria were performed . RESULTS DNA str and breaks in sperm cell nuclei were found significantly more often in sperm sample s from men suffering from unexplained infertility compared to those from normal fertile men , and significantly more rarely compared with sperm sample s from men with oligozoospermia . The percentages of normal spermatozoa ( Krüger 's strict criteria ) were significantly lower in sample s from men suffering from unexplained infertility compared to those of normal fertile men , but significantly higher compared to those of men with oligozoospermia . No difference was found between first and second day sample s used for insemination , as regards DNA str and breaks , sperm cell morphology , total number of motile sperm cells , activation and motility degree . CONCLUSION The present data suggest that a subgroup of men suffering from unexplained infertility have DNA str and breaks in their sperm cell DNA . This group might suffer from the same malfunction as many men with oligozoospermia , however , their apoptotic activated sites in the testis are different . Delivery of sperm sample s with 24 hours interval does not affect any sperm cell counts , CASA , DNA str and breaks or morphology findings in sperm sample s from men suffering from unexplained infertility OBJECTIVE To examine sperm DNA fragmentation in semen used for assisted reproduction procedures to establish this factor 's prognostic role in fertilization rate , embryo development , pregnancy rate , and outcome . DESIGN Prospect i ve study . SETTING Department of Medicine and Biology of Reproduction of the Edouard Herriot Hospital in Lyon , France . PATIENT(S ) 322 couples , divided into 88 cycles of in vitro fertilization ( IVF ) or 234 cycles of intracytoplasmic sperm injection ( ICSI ) .  INTERVENTION(S ) Sperm DNA fragmentation was detected in sperm obtained 2 to 5 months before the ART procedure . MAIN OUTCOME MEASURE(S ) Sperm DNA fragmentation was measured with the  terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling ( TUNEL ) technique .  RESULT ( S ) There was a negative statistical correlation between the rate of fragmentation and the semen characteristics . A statistically significant negative relationship was found for sperm DNA fragmentation and fertilization when ICSI and IVF were compared . With ICSI , a statistically significant negative relationship was found between fertilization rate and percentage of sperm DNA fragmentation ( DNA fragmentation index , or DFI ) . The risk of nontransfer due to blocked embryo development increased when the DFI exceeded 15 % ( 18.2 % for ICSI vs 4.2 % for IVF ) with an odds ratio of 5.05 . The miscarriage risk increased fourfold when the DFI exceeded 15 % ( 37.5 % for ICSI vs 8.8 % for IVF ) . CONCLUSION ( S ) Sperm DNA fragmentation measured 2 to 5 months before the assisted reproduction procedure was a prognostic indicator of the fertilization , pregnancy , and miscarriage rates and the pregnancy outcome Background Sperm DNA damage is associated with male infertility but whether normozoospermic infertile men also have DNA damage is unknown . Objective To evaluate sperm DNA and chromatin integrity in men with mild male factor infertility . Design , setting and participants Prospect i ve study of 102 consecutive men ( 78 normozoospermic , 15 asthenozoospermic , 9 oligozoospermic ) enrolled for intrauterine insemination ( IUI ) and 15 fertile controls .  Outcome measurements and statistical analysis St and ard semen parameters and sperm chromatin and DNA integrity were assessed and compared between groups . Sperm chromatin quality was assessed by ( 1 ) aniline blue staining ( AB is specific to histone lysines ) , ( 2 ) iodoacetamide fluorescein fluorescence ( IAF targets free protamine sulfhydryl groups ) and ( 3 ) sperm chromatin structure  assay ( SCSA ) with the results expressed as % DNA fragmentation index ( % DFI ) . Results and limitations The mean ( ±SD ) percentage of spermatozoa with positive IAF fluorescence was significantly higher in the IUI population compared to fertile controls ( 17 % ± 10 % vs. 8 % ± 6 % , P = 0.0011 ) and also in the normozoospermic subset ( n = 78 ) compared to controls ( 16 % ± 9 % vs. 8 % ± 6 % , P < 0.0001 , ANOVA ) . We also observed a trend toward lower % progressive motility , and higher % AB staining and % DFI in the IUI group compared to controls . We observed significant relationships between sperm % DFI and progressive motility ( r = −0.40 , P < 0.0001 ) and between positive AB staining and IAF fluorescence ( r = 0.58 , P < 0.0001 ) . Conclusions The data indicate that sperm chromatin integrity may be abnormal in men enrolled in IUI treatment cycles , despite the fact that most of these men are normozoospermic A representation and interpretation of the area under a receiver operating characteristic ( ROC ) curve obtained by the " rating " method , or by mathematical predictions based on patient characteristics , is presented . It is shown that in such a setting the area represents the probability that a r and omly chosen diseased subject is ( correctly ) rated or ranked with greater suspicion than a r and omly chosen non-diseased subject . Moreover , this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic . These two relationships are exploited to ( a ) provide rapid closed-form expressions for the approximate magnitude of the sampling variability , i.e. , st and ard error that one uses to accompany the area under a smoothed ROC curve , ( b ) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area , and ( c ) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques BACKGROUND We aim ed to investigate whether sperm DNA quality may predict intrauterine insemination ( IUI ) outcome . METHODS The study was design ed in a prospect i ve cohort fashion , at a tertiary centre for reproductive medicine . A total of 119 patients underwent 154 cycles of IUI .  Parameters related to demography , cycle management and semen sample used for IUI were evaluated . Conventional semen parameters , morphology ( strict criteria ) , sperm DNA fragmentation and stability [ evaluated by terminal deoxynucleotidyl transferase-mediated dUDP nick-end labelling ( TUNEL ) and acridine orange staining under both acid and acid + heat denaturing conditions respectively ] were measured . The main outcome measure was clinical pregnancy , defined as ultrasonographic visualization of intrauterine gestational sac(s ) . RESULTS Logistic regression analyses were done on six sets of data , including all cycles combined , cycles with washed sample s , first cycle of each couple , first cycle of each couple with washed sample s , cycles stimulated with gonadotrophins and finally gonadotrophin-stimulated cycles with washed sample s. The number of pre-ovulatory follicles on day of hCG , the age of the woman and the percentage of sperm with acid- + heat-resistant DNA were the parameters that predicted IUI outcome in most of these data subsets . For the gonadotrophin-stimulated cycles , age of the man appeared as a predictor as opposed to that of the woman ; and for the cycles within this subgroup , where the semen sample was washed , sperm DNA fragmentation and age of the man were the only two parameters to predict IUI outcome . No sample s with > 12 % of sperm having DNA fragmentation result ed in pregnancy . CONCLUSIONS The number of follicles , age of the woman/man and sperm DNA quality may predict IUI outcome OBJECTIVE To compare sperm chromatin dispersion ( SCD ) test with terminal deoxynucleotidyle transferase-mediated terminal uridine nick-end labeling ( TUNEL ) assay in assessing DNA fragmentation 
    Output:
    
Overall , the sperm DNA fragmentation tests had a reasonable to good sensitivity .
A wide variety of other factors may also affect the IVF/ICSI outcome , reflected by limited to very low specificity .
The SCSA and the SCD test had poor predictive capacity .
Importantly , for the TUNEL assay , SCD test and Comet assay , meta-regression showed no differences in predictive value between IVF and ICSI .
The present review suggests that current sperm DNA fragmentation tests have limited capacity to predict the chance of pregnancy in the context of MAR .
Furthermore , sperm DNA fragmentation tests have little or no difference in predictive value between IVF and ICSI .
At this moment , there is insufficient evidence to recommend the routine use of sperm DNA fragmentation tests in couples undergoing MAR both for the prediction of pregnancy and for the choice of treatment .