ArticleEuropean journal of medical research2026
Sperm DNA fragmentation and assisted reproduction: an umbrella meta-analysis.
Article in European journal of medical research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed.
- Impact of Environmental Conditions During IVF Laboratory Handling on Sperm Quality.International journal of molecular sciences · 2026Article
- Sequencing Matters: Comparative Effectiveness of Density-Gradient Centrifugation and MACS for Enhancing Sperm Quality and DNA Integrity.Journal of clinical medicine · 2026Article
- Clustering of sperm by chromatin integrity features reveals breed and monthly effects, as well as a link between double-strand DNA breaks and litter size in pigs.BMC veterinary research · 2026Article
- Integrating Sperm Microscopy, Environmental Exposures, and Lifestyle Factors for Male Fertility Analysis: Protocol for the Nippon Semen and Environmental Exposure Database (N-SEED) Cross-Sectional Study.JMIR research protocols · 2026Article
- Association of sperm DNA fragmentation with abstinence duration, seminal oxidative stress and age: a call to consider abstinence in andrological diagnostics.Frontiers in urology · 2026Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundMale infertility accounts for nearly half of infertility cases worldwide. Conventional semen parameters provide limited information about sperm function. Sperm DNA fragmentation (SDF) has emerged as a potential biomarker of sperm nuclear quality, but its prognostic role in assisted reproductive technology (ART) outcomes remains controversial.
objectivesTo conduct an umbrella meta-analysis of published meta-analyses assessing the association between SDF and major ART outcomes, including clinical pregnancy (CP), pregnancy loss (PL), and live birth rate (LBR).
methodsWe systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library through July 2025. Eligible studies were systematic reviews with meta-analyses evaluating SDF in in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and intrauterine insemination (IUI). Pooled risk ratios (RRs) were extracted or converted to logRRs. Evidence quality was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) frameworks.
resultsEight meta-analyses comprising more than 25,000 ART cycles were included. Elevated SDF was significantly associated with reduced CP in IVF (RR = 0.662, 95% CI: 0.547-0.801) and IUI (RR = 0.467, 95% CI: 0.242-0.900), while only a weak, borderline association was observed in ICSI (RR = 0.886, 95% CI: 0.764-0.985). High SDF was strongly associated with increased PL in ICSI (RR = 2.286, 95% CI: 1.383-3.779). Evidence for LBR was limited and inconclusive. Across outcomes, certainty of evidence was graded as low due to heterogeneity, imprecision, and methodological limitations.
conclusionsElevated SDF adversely affects ART outcomes, with consistent negative associations in IVF and IUI, a weak effect in ICSI, and a strong link to miscarriage in ICSI. These findings clarify the prognostic role of SDF and emphasize the need for standardized assays and large-scale prospective studies before routine clinical implementation.
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