Does male infertility play a role in recurrent miscarriage?

By (gynecologist) and (embryologist).
Last Update: 05/06/2021

The male factor has certainly been underestimated when looking for the causes of recurrent gestational loss. Despite this, there are studies that seem to link, for example, sperm DNA fragmentation with recurrent miscarriage.

This type of abortion can be caused by uterine, genetic or immunological alterations, among others. However, the causes of recurrent miscarriage are unknown in about half of the cases. When the reason has not been discovered, it is called anidiopathic recurrent miscarriage.

What is recurrent miscarriage?

Recurrent miscarriage is the loss of 2 or more pregnancies, although there may be some controversy here, as the loss of 3 or more consecutive pregnancies may also be considered recurrent miscarriage. Despite this, the truth is that the study of the couple can be carried out once the second gestational loss has occurred.

Generally, the search for the causes of repeat Miscarriage has focused on the woman. As for the male, in addition to the semen analysis, it is common to study his karyotype.

This test is also performed on the female and is used to rule out certain chromosomal abnormalities. Genetic alterations can be balanced and go unnoticed in the adult individual. However, these balanced alterations can give rise to gametes, and therefore embryos, with an unbalanced genetic content.

Thus, this type of alteration in the parents increases the risk of recurrent miscarriage. However, as mentioned above, in many cases the tests performed fail to clarify the cause of repeated miscarriage. This is why the role of the male factor has been studied. For this purpose, other seminal aspects have been analysed apart from the basic parameters evaluated in the semenogram.

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Oxidative stress

Oxidative stress may be a cause of male infertility. It is an imbalance between reactive oxygen species (ROS) and the levels of antioxidants that neutralize them. Under these conditions, oxidative stress can affect sperm membrane and DNA integrity. This may alter basic parameters such as sperm motility or morphology, but also appears to be related to recurrent miscarriage.

Studies have found that men from couples who have experienced recurrent miscarriage have higher levels of ROS in semen and increased sperm DNA fragmentation. In addition, sperm motility and sperm morphology were also affected in these males. However, sperm DNA fragmentation may be elevated without affecting basic seminal parameters.

Sperm DNA Fragmentation

Sperm DNA damage has been linked to male infertility. The causes of sperm DNA fragmentation are varied: smoking, environmental pollutants, heat exposure, chemotherapy, altered maturation of germ cells or oxidative stress.

Fragmentation in sperm DNA can affect natural conception as well as the results of assisted reproduction. Elevated sperm DNA fragmentation has been associated with an increased risk of miscarriage after IVF/ICSI and has been shown to be increased in semen from males with a history of recurrent miscarriage.

However, more research is needed on this topic. It would be necessary to clarify whether the improvement of oxidative stress and sperm DNA fragmentation, for example with lifestyle changes or antioxidant intake, would have a beneficial effect on subsequent pregnancy. Nevertheless, it is always advisable to lead a healthy lifestyle, maintain a healthy weight, avoid smoking and alcohol and exercise moderately.

Sperm aneuploidy

Aneuploidies are alterations in the number of chromosomes. Therefore, another possible male cause of recurrent miscarriage could be an increased rate of aneuploidy in the sperm, despite the male having a normal karyotype.

The sperm contributes half of the genetic content of the embryo, so defects in the number of chromosomes in the sperm can lead to non-viable embryos due to altered genetic content.

There are tests such as sperm FISH, which indicates the number of copies of each chromosome studied in the sperm. In the case of being altered, the couple could be recommended to undergo a preimplantation genetic test (PGT).

You can read in more detail what FISH of spermatozoa consists of in the following link: Fluorescent in situ hybridization (FISH): Alterations in Sperm Cells.

FAQs from users

Can repeated miscarriages have a male cause?

By Ricardo Celís García M.D., M.Sc. (gynecologist).

The truth is that, after a detailed study of the individual case, we are sometimes unable to make an aetiological diagnosis. That is, we do not determine the cause of the miscarriages. It is important to note that in couples with repeated miscarriages in which the cause of the miscarriages is not found, the probability of a subsequent full-term pregnancy is greater than 50%.

Among the most common causes of repeat miscarriages are genetic causes and the so-called primary antiphospholipid syndrome.

However, recent studies point to a possible male factor as the origin of repeat miscarriages. In recent years, semen quality has declined, largely due to stress, long working hours, environmental pollution, exposure to heat, alcohol and tobacco, poor eating habits and even the use of tight underwear.

Imagen: Factors that diminish semen quality

Tests are available to identify chromosomal alterations in semen samples.

Does poor semen quality influence miscarriages?

By Silvia Azaña Gutiérrez B.Sc., M.Sc. (embryologist).

Studies seem to link poor semen quality, in terms of oxidative stress, sperm DNA fragmentation and sperm aneuploidy rate, with repeat miscarriage.

It is important to mention that these semen parameters are not studied in the basic semen analysis, but it is necessary to perform other complementary tests such as FISH of spermatozoa or the study of sperm DNA fragmentation.

Suggested for you

If you want to learn more about recurrent miscarriage, you can visit the following link: What is recurrent miscarriage? - Causes, diagnosis and Treatment.

On the other hand, you are interested in knowing more about sperm quality, we recommend you to read this article: Semen Quality : What Is Measured And What Can Be Done To Improve It?

We make a great effort to provide you with the highest quality information.

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Agarwal A, Majzoub A, Baskaran S, Panner Selvam MK, Cho CL, Henkel R, Finelli R, Leisegang K, Sengupta P, Barbarosie C, Parekh N, Alves MG, Ko E, Arafa M, Tadros N, Ramasamy R, Kavoussi P, Ambar R, Kuchakulla M, Robert KA, Iovine C, Durairajanayagam D, Jindal S, Shah R. Sperm DNA Fragmentation: A New Guideline for Clinicians. World J Mens Health. 2020 Oct;38(4):412-471.

Bareh GM, Jacoby E, Binkley P, Chang TC, Schenken RS, Robinson RD. Sperm deoxyribonucleic acid fragmentation assessment in normozoospermic male partners of couples with unexplained recurrent pregnancy loss: a prospective study. Fertil Steril. 2016 Feb;105(2):329-36.e1.

Brahem S, Mehdi M, Landolsi H, Mougou S, Elghezal H, Saad A. Semen parameters and sperm DNA fragmentation as causes of recurrent pregnancy loss. Urology. 2011 Oct;78(4):792-6.

Bronson R. Role of spermatozoa in the etiology of miscarriage. Fertil Steril. 2016 Jan;105(1):47-8.

ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, Middeldorp S, Nelen W, Peramo B, Quenby S, Vermeulen N, Goddijn M. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018 Apr 6;2018(2):hoy004.

du Fossé NA, van der Hoorn MP, van Lith JMM, le Cessie S, Lashley EELO. Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis. Hum Reprod Update. 2020 Sep 1;26(5):650-669.

Imam SN, Shamsi MB, Kumar K, Deka D, Dada R. Idiopathic recurrent pregnancy loss: role of paternal factors; a pilot study. J Reprod Infertil. 2011 Oct;12(4):267-76.

Jayasena CN, Radia UK, Figueiredo M, Revill LF, Dimakopoulou A, Osagie M, Vessey W, Regan L, Rai R, Dhillo WS. Reduced Testicular Steroidogenesis and Increased Semen Oxidative Stress in Male Partners as Novel Markers of Recurrent Miscarriage. Clin Chem. 2019 Jan;65(1):161-169.

Kamkar N, Ramezanali F, Sabbaghian M. The relationship between sperm DNA fragmentation, free radicals and antioxidant capacity with idiopathic repeated pregnancy loss. Reprod Biol. 2018 Dec;18(4):330-335.

McQueen DB, Zhang J, Robins JC. Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril. 2019 Jul;112(1):54-60.e3.

Ramasamy R, Scovell JM, Kovac JR, Cook PJ, Lamb DJ, Lipshultz LI. Fluorescence in situ hybridization detects increased sperm aneuploidy in men with recurrent pregnancy loss. Fertil Steril. 2015 Apr;103(4):906-909.e1.

Robinson L, Gallos ID, Conner SJ, Rajkhowa M, Miller D, Lewis S, Kirkman-Brown J, Coomarasamy A. The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis. Hum Reprod. 2012 Oct;27(10):2908-17.

Zidi-Jrah I, Hajlaoui A, Mougou-Zerelli S, Kammoun M, Meniaoui I, Sallem A, Brahem S, Fekih M, Bibi M, Saad A, Ibala-Romdhane S. Relationship between sperm aneuploidy, sperm DNA integrity, chromatin packaging, traditional semen parameters, and recurrent pregnancy loss. Fertil Steril. 2016 Jan;105(1):58-64.

FAQs from users: 'Can repeated miscarriages have a male cause?' and 'Does poor semen quality influence miscarriages?'.

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Authors and contributors

 Ricardo Celís García
Ricardo Celís García
M.D., M.Sc.
Dr. Ricardo Celís has a degree in Medicine and is a specialist in Gynaecology and Obstetrics. More information about Ricardo Celís García
License: 483906001
 Silvia Azaña Gutiérrez
Silvia Azaña Gutiérrez
B.Sc., M.Sc.
Graduate in Health Biology from the University of Alcalá and specialized in Clinical Genetics from the same university. Master in Assisted Reproduction by the University of Valencia in collaboration with IVI clinics. More information about Silvia Azaña Gutiérrez
License: 3435-CV

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