SynthesisFrontiers in endocrinology2026
Comparative analysis of sperm preparation techniques on DNA fragmentation and clinical outcomes: a network meta-analysis.
Synthesis in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
5 authors.
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Abstract
Introduction: Elevated sperm DNA fragmentation negatively affects assisted reproductive technology outcomes. Although multiple sperm preparation techniques are used, existing evidence is largely limited to pairwise comparisons. We performed a systematic review and network meta-analysis to investigate the most effective technique for reducing sperm DNA fragmentation and improving clinical outcomes. Methods: PubMed, Embase and Cochrane Central Register of Controlled Trials were searched to July 26, 2025. Due to the limited randomized studies for sperm DNA fragmentation (N=2), both randomized and non-randomized studies comparing at least two preparation techniques were included for sperm DNA fragmentation analyses, while only randomized controlled trials were included for clinical outcomes to ensure the highest stringency for treatment efficacy. Data were synthesized using frequentist random-effect network meta-analysis. Results: Forty-two studies (2697 semen samples) were included for sperm DNA fragmentation. Despite high heterogeneity ( Discussion: While MFSS and MACS-based combinations showed the greatest numerical reduction in sperm DNA fragmentation, these findings are characterized by high heterogeneity and low certainty of evidence. Although some improvements in clinical pregnancy and miscarriage rates were observed with the combination of MACS and DGC, the lack of robust, large-scale data prevents a definitive clinical recommendation outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251181955, identifier CRD420251181955.
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