First, the PICSI link? yup that is it. Notice the comments made by the ASRM are from 2008. That's a long time ago in terms of the IF field! Great article links...I think those really do a good job of explaining this issue.
I actually have quite a good working knowledge of statistics and medical research in general, so these are meaningful to me (and hopefully to others!).
The first link shows us how DNA fragmentation was the single best predictor of pregnancy success with donor sperm. And this is a large sample, really well designed study (which means it has lots of reliability and validity):
Summary of findings- "Conclusion: Both the integrity of plasma membrane and DNA in spermatozoa are crucial factors affecting the fecundity of sperm donors. Therefore, the addition of some of these new tests to routine semen analysis could significantly improve the recruitment of sperm donors and the clinical pregnancy rate of anonymous donors."
This second link focuses just on IVF couples. It shows the same thing...DNA frag is a major predictor of success/failure:
Summary of findings- "Abnormality of sperm chromatin structure is one of the reasons for IVF-ET failure. Examination of sperm chromatin structure is helpful in predicting the risk of IVF-ET failure and optimizing treatment of infertility."
And yet another link, with similar results:
Summary of findings- "This study shows that fertilization rates are directly dependent upon both sperm progressive motility and DNA fragmentation, but sperm DNA fragmentation is a much stronger test."
These are about the relationship between DNA frag and miscarriage:
For me, these are a big deal...we had an early m/c. And I am not just going to keep letting these docs tell me that it is because of my egg quality when it might actually be something else...and something we could fix!!! We can't fix my eggs...bet there are techniques to fix this issue!
I must say, the more I look into this, the more I am convinced that this should be a standard part of our screening. As I have mentioned, we are waiting for the approval to get DH tested. Insurance might actually pay for it. But even if they don't, we will go out of pocket.