Zhang Lei, Li Honglin, Han Letian, Zhang Liang, Zu Zhihui, Zhang Jianwei
The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
Reproductive and Genetic Center of Integrated Traditional and Western Medicine, Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, China.
J Obstet Gynaecol Res. 2024 Apr;50(4):545-556. doi: 10.1111/jog.15886. Epub 2024 Jan 10.
Recurrent pregnancy loss (RPL) is a common clinical reproductive problem. With research advancements, an increasing number of studies have suggested that male factors play an important role in RPL. However, the evaluation results of male sperm quality in published meta-analyses are inconsistent. We aimed to summarize the evidence of the association between semen factors and RPL and evaluate the level and validity of the evidence.
We searched PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases for systematic reviews or meta-analyses to evaluate the association between male semen parameters and RPL. The methodological quality of the included meta-analyses was assessed, and data and evidence were re-synthesized and stratified using a random-effects model.
Seven meta-analyses and nine semen parameters were included in the final analysis. The methodological quality of all publications was considered low or very low. There was highly suggestive evidence for the association between sperm DNA fragmentation (SDF), sperm progressive motility rate, and RPL (class II). The evidence level for the association between sperm concentration, normal sperm morphology, sperm deformity rate, total motility, and RPL was suggestive evidence (class III). The evidence level for the association between sperm volume and sperm count and RPL was weak (class IV). There was no significant association between sperm pH and RPL (class NS).
Our results suggest level II evidence for the association between male SDF and RPL, while the evidence level for the association between conventional semen routine parameters and RPL was low (classes III and IV).
复发性流产（RPL）是一种常见的临床生殖问题。随着研究的进展，越来越多的研究表明男性因素在RPL中起重要作用。然而，已发表的荟萃分析中男性精子质量的评估结果并不一致。我们旨在总结精液因素与RPL之间关联的证据，并评估证据的水平和有效性。
我们检索了PubMed、Cochrane图书馆、EMBASE、科学网和Scopus数据库，以查找系统评价或荟萃分析，以评估男性精液参数与RPL之间的关联。评估纳入的荟萃分析的方法学质量，并使用随机效应模型对数据和证据进行重新合成和分层。
最终分析纳入了7项荟萃分析和9项精液参数。所有出版物的方法学质量被认为低或非常低。有高度提示性证据表明精子DNA碎片率（SDF）、精子前向运动率与RPL之间存在关联（II级）。精子浓度、正常精子形态、精子畸形率、总运动率与RPL之间关联的证据水平为提示性证据（III级）。精液体积和精子计数与RPL之间关联的证据水平较弱（IV级）。精子pH值与RPL之间无显著关联（NS级）。
我们的结果表明男性SDF与RPL之间关联的证据为II级，而传统精液常规参数与RPL之间关联的证据水平较低（III级和IV级）。
