The Association of DNA Fragmentation Index, Protamine Deficiency and Basic Semen Parameters: A Cross-sectional Analytical Study.

BACKGROUND

Conventional semen analysis may overlook defects in sperm nuclear integrity, whereas molecular markers such as DNA Fragmentation Index (DFI) and protamine deficiency provide complementary information on sperm chromatin quality.

AIM: The aim of this study was to investigate the associations between conventional semen parameters and two clinically relevant markers of sperm chromatin integrity: DFI and protamine deficiency assessed by chromomycin A3 (CMA3) staining.

SETTINGS AND

DESIGN

This was a cross-sectional analytical study conducted in a certified private andrology laboratory operating under standardised quality control protocols.

MATERIALS AND

METHODS

A total of 150 men undergoing fertility evaluation between 2022 and 2024 were included. Semen analysis was performed according to the World Health Organization 2021 guidelines;[1] DFI was assessed using the Halosperm sperm chromatin dispersion test, and chromatin maturity was evaluated by CMA3 staining.

STATISTICAL ANALYSIS USED: Non-parametric statistical methods were applied to evaluate correlations between molecular markers (DFI and CMA3) and semen parameters.

RESULTS

Elevated DFI and CMA3 were significantly and inversely correlated associated with total motility, progressive motility, vitality and normal morphology (P < 0.01), while DFI correlated positively with CMA3 positivity (ρ = 0.54, P < 0.001). Men with DFI >30% or CMA3 >40% showed significantly reduced semen quality parameters.

CONCLUSIONS

DFI and CMA3 are strongly associated with key semen parameters and provide complementary information on sperm nuclear integrity with potential clinical relevance in male infertility.