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Objective: To study the implications of sperm DNA fragmentation (SDF) in intracytoplasmic sperm injection cycles for non-male factor infertility. Design: Prospective cohort study. Setting: Private university-affiliated IVF center. Patient(s): Data from 475 cycles performed from June 2016 to June 2017. Intervention(s): Cycles were divided according to SDF rate into two groups: <30% SDF (n ¼ 433) and R30% SDF (n ¼ 42). Laboratory and clinical outcomes were compared between groups by generalized linear models adjusted for potential confounders. Main Outcome Measure(s): Embryo quality and miscarriage rates. Result(s): Fertilization rate was similar between groups (R30% SDF, 85.28% AE 1.06% vs. <30% SDF, 90.68% AE 3.61%). Significantly lower rates of normal cleavage speed (R30% SDF, 61.12% AE 4.21% vs. <30% SDF, 72.53% AE 1.24%), high-quality embryos at day 3 (R30% SDF, 23.07% AE 5.56% vs. <30% SDF, 36.41% AE 1.53%), blastocyst formation (R30% SDF, 39.09% AE 2.73% vs. <30% SDF, 58.83% AE 7.59%), blastocyst quality (R30% SDF, 11.97% AE 1.22% vs. <30% SDF, 30.09% AE 2.39%), and implantation (33.24% AE 1.66% vs. <30% SDF, 46.40% AE 4.61%) were observed in cycles with higher SDF, despite similar pregnancy rates (R30% SDF, 30.40% vs. <30% SDF, 32.40%). A 2.5-fold miscarriage rate was observed in cycles with an SDF above the established cutoff (R30% SDF, 42.8% vs. <30% SDF, 16.8%). Conclusion(s):Higher SDF is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in nonmale factor infertility intracytoplasmic sperm injection cycles. Since defects in sperm may be hidden, the SDF test can bring additional information to the sperm quality evaluation of men with unknown infertility history. (Fertil Steril Ò 2019;112:483-90. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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