https://doi.org/10.4081/aiua.2026.14995
Body mass index and sperm morphology as independent predictors of increased sperm DNA fragmentation after cryopreservation in men with severe oligoasthenoteratozoospermia
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Published: 22 June 2026
Background: Semen cryopreservation is vital for fertility preservation in men with oligoasthenoteratozoospermia (OAT). While cryopreservation increases sperm DNA fragmentation (SDF), patient-specific risk factors in severe OAT remain poorly defined. We aimed to quantify the change in DNA fragmentation index (DFI) and identify clinical predictors of susceptibility.
Methods: This retrospective cohort study enrolled 340 men with severe OAT (sperm count < 5 million/mL, total motility < 42%, progressive motility < 30%, morphology < 4%). DFI was assessed in fresh and post-thaw samples using the TUNEL assay. Correlations and multivariate regression analyses evaluated relationships between DFI change and age, body mass index (BMI), sperm parameters, and smoking status.
Results: The mean DFI increased significantly from 22.0% (IQR 15.0-29.0%) in fresh semen to 36.0% (IQR 23.0-54.0%) postcryopreservation (p < 0.001). The median absolute increase (ΔDFI) was 9.5% (IQR 6.0-25.0%). Univariate analysis identified significant correlations between the ΔDFI and higher BMI (ρ = 0.544, p < 0.001), lower sperm count (ρ = -0.638, p < 0.001), and poorer sperm morphology (ρ = -0.669, p < 0.001). In the final multivariate linear regression model, higher BMI and poorer sperm morphology remained the only significant independent predictors of a greater increase in DFI after cryopreservation (both p < 0.001). This model explained 93.7% of the variance in the ΔDFI (Adjusted R² = 0.937, p < 0.001). Age and sperm count were not independent predictors in the final model. Smoking status and varicocele grade were not significantly associated with the ΔDFI.
Conclusions: Cryopreservation significantly exacerbates sperm DNA damage in severe OAT, but this effect is not uniform. Higher BMI and poorer sperm morphology are independent risk factors for greater damage, identifying a vulnerable patient subgroup. These men may benefit from personalized counseling and optimized cryopreservation protocols to mitigate DNA damage and improve future assisted reproductive technology outcomes.
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Ethics Approval
CRediT authorship contribution
Ahmed Rabie: Conceptualization, Data collection, Data analysis, Writing – original draft.; Mahmoud Khalil: Critical revision, Supervision; Maurizio Buscarini: Methodology, Critical revision, Supervision; Moustafa Elsawy: Critical revision, Supervision; Ahmed Balah: Methodology, Critical revision, Supervision; Maida Bada: Supervision, Data analysis; Mohamed Jabbo: Critical revision, Supervision; Osama Zaytoun: Methodology, Critical revision, Supervision.
Data Availability Statement
The data that support the findings of this study are available from the corresponding Author upon reasonable request. Due to patient privacy and institutional regulations, the data are not publicly available
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