Szabó Anett, Váncsa Szilárd, Hegyi Péter, Kói Tamás, Ács Júlia, Hermánné Réka Juhász, Ács Nándor, Szarvas Tibor, Nyirády Péter, Kopa Zsolt
Department of Urology, Semmelweis University, Üllői út 78/b, H-1082, Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Sci Rep. 2025 Mar 24;15(1):10118. doi: 10.1038/s41598-025-93267-z.
Infertility affects 15% of couples in developed countries, 50% accounting for male origin. In 2021, sperm DNA fragmentation (SDF) testing was incorporated into male fertility evaluations as an evidence-based functional test. We aimed to assess the effect of interventions that could potentially improve SDF. A random-effect meta-analysis was performed with a systematic search in three databases. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated. Initially, 36,531 articles were found, of which 86 papers with over 8,000 patients were included. Three months following varicocelectomy, the decrease in SDF was -6.74% (CI: -9.40, -4.08) compared to preoperative data of patients, whereas it was -12.39% (CI: -22.41, -2.36) after six months and -10.06% (CI: -22.69, + 2.56) at twelve months. A dose-dependent effect could also be observed in grade II and III varicoceles. The overall SDF decrease at three months was -4.27% (CI: -6.11, -2.43) for antioxidants, -4.51% (CI: -6.81, -2.20) for combined antioxidant therapy and -3.36% (CI: -4.44, -2.28) for monotherapy. In terms of follicle-stimulating hormone treatment (FSH) at three months, the change in SDF was -6.66% (CI: -9.64, -3.69). For lifestyle modifications, a change of -3.24% (CI: -5.33, -1.16) was observed at three months. Other interventions are narratively summarized in the systematic review. Of the interventions reviewed, varicocelectomy is the most effective in reducing SDF at six months, FSH treatment might be useful, antioxidants appear questionable, and lifestyle interventions require more studies of similar designs to draw firm conclusions.
在发达国家，15%的夫妇受到不孕不育的影响，其中50%源于男性因素。2021年，精子DNA碎片率（SDF）检测作为一项循证功能检测被纳入男性生育力评估中。我们旨在评估可能改善SDF的干预措施的效果。通过在三个数据库中进行系统检索，开展了一项随机效应荟萃分析。计算了合并平均差（MD）及95%置信区间（CI）。最初检索到36,531篇文章，其中86篇论文纳入了8000多名患者。与患者术前数据相比，精索静脉曲张切除术后三个月，SDF下降了-6.74%（CI：-9.40，-4.08），而术后六个月下降了-12.39%（CI：-22.41，-2.36），十二个月时下降了-10.06%（CI：-22.69，+2.56）。在II级和III级精索静脉曲张中也可观察到剂量依赖性效应。抗氧化剂在三个月时SDF总体下降了-4.27%（CI：-6.11，-2.43），联合抗氧化治疗下降了-4.51%（CI：-6.81，-2.20），单一疗法下降了-3.36%（CI：-4.44，-2.28）。在三个月时，促卵泡生成素治疗（FSH）方面，SDF的变化为-6.66%（CI：-9.64，-3.69）。对于生活方式改变，三个月时观察到变化为-3.24%（CI：-5.33，-1.16）。系统评价中对其他干预措施进行了叙述性总结。在所审查的干预措施中，精索静脉曲张切除术在六个月时降低SDF最有效，FSH治疗可能有用，抗氧化剂效果存疑，生活方式干预需要更多类似设计的研究才能得出确切结论。
