The Association between Male Serum Uric Acid Concentration and In Vitro Fertilization and Embryo Transfer (IVF-ET) Outcomes: A Retrospective Study

Purpose This retrospective study investigated the association between male serum uric acid (UA) levels and in vitro fertilization (IVF) outcomes, focusing on sperm DNA fragmentation index (DFI). Methods We analyzed data from 851 couples. Males were categorized into normouricemic (n = 607) and hyperuricemia (HUA, n = 244) groups. We compared semen parameters, sperm DFI, and IVF outcomes (high-quality embryo rate, live birth rate). Multivariable analyses identified predictors of live birth and DFI. Results The HUA group had a higher rate of male obesity (83.19% vs. 59.8%, p  < 0.001). Conventional semen parameters were similar, but the HUA group had a significantly lower sperm DFI (13.46% vs. 16.25%, p  < 0.001). IVF outcomes were superior in the HUA group, with a higher high-quality embryo rate (21.36% vs. 16.29%, p  < 0.001) and a higher live birth rate per cycle (61.07% vs. 50.25%, p  = 0.005). Regression analysis confirmed serum UA as an independent positive predictor of live birth (aOR = 1.002, 95% CI: 1.001 ~ 1.004, p  = 0.011) and a negative predictor of elevated DFI (aOR = 0.993, 95% CI: 0.991 ~ 0.995, p  < 0.001). Conclusions Higher male serum UA levels were associated with reduced sperm DNA fragmentation and improved IVF outcomes. This suggests a potential protective role of UA in male fertility, warranting a reconsideration of its metabolic role in reproductive contexts.