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Meta-Analysis
. 2023 Jan 18;21(1):5.
doi: 10.1186/s12958-023-01054-0.

Lifestyle-, environmental-, and additional health factors associated with an increased sperm DNA fragmentation: a systematic review and meta-analysis

Anett Szabó  1   2 , Szilárd Váncsa  2   3   4 , Péter Hegyi  2   3   4 , Alex Váradi  2 , Attila Forintos  2 , Teodóra Filipov  2   5 , Júlia Ács  1   2 , Nándor Ács  2   6 , Tibor Szarvas  1   2   7 , Péter Nyirády  1   2 , Zsolt Kopa  8   9
Affiliations
Meta-Analysis

Lifestyle-, environmental-, and additional health factors associated with an increased sperm DNA fragmentation: a systematic review and meta-analysis

Anett Szabó et al. Reprod Biol Endocrinol. .

Abstract

Introduction: Infertility affects one in every six couples in developed countries, and approximately 50% is of male origin. In 2021, sperm DNA fragmentation (SDF) testing became an evidence-based test for fertility evaluations depicting fertility more clearly than standard semen parameters. Therefore, we aimed to summarize the potential prognostic factors of a higher SDF.

Methods: We conducted a systematic search in three medical databases and included studies investigating any risk factors for SDF values. We calculated mean differences (MD) in SDF with 95% confidence interval (CI) for exposed and non-exposed individuals.

Results: We included 190 studies in our analysis. In the group of associated health conditions, varicocele (MD = 13.62%, CI: 9.39-17.84) and impaired glucose tolerance (MD = 13.75%, CI: 6.99-20.51) had the most significant increase in SDF. Among malignancies, testicular tumors had the highest impact, with a maximum of MD = 11.3% (CI: 7.84-14.76). Among infections, the overall effects of both Chlamydia and HPV were negligible. Of lifestyle factors, smoking had the most disruptive effect on SDF - an increase of 9.19% (CI: 4.33-14.06). Different periods of sexual abstinence did not show significant variations in SDF values. Age seemed to have a more drastic effect on SDF from age 50 onwards, with a mean difference of 12.58% (CI: 7.31-17.86). Pollution also had a detrimental effect - 9.68% (CI: 6.85-12.52).

Conclusion: Of the above risk factors, varicocele, impaired glucose tolerance, testicular tumors, smoking, pollution, and paternal age of over 50 were associated with the highest SDF.

Trial registration: CRD42021282533.

Keywords: DFI; DNA fragmentation index; Infertility; Male fertility; Prognostic factors; Reproductive medicine; SDF; Sperm DNA fragmentation; Sperm quality.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flowchart showing the study selection process
Fig. 2
Fig. 2
Summary forest plot of associated health conditions
Fig. 3
Fig. 3
Summary forest plot of lifestyle factors
Fig. 4
Fig. 4
Summary forest plot of other factors
See this image and copyright information in PMC

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