Table 1.
General characteristics of the studies included in the network meta-analysis for sperm DNA fragmentation.
| First author (year) | Country | Study design | Methods compared | Sample size(N) | DFI assay | Key outcomes reported | Participant characteristics |
|---|---|---|---|---|---|---|---|
| Hsu et al., (17) | China | Prospective non-randomized | MFSS (Zymot) and DGC | 119 | SCD | DFI, post-selection concentration and post-selection progressively motility | Normozoopsermic (N = 35) Non-normozoospermic (N = 85) |
| Kishi et al., (18) | Japan | Prospective non-randomized | MFSS (Qualis) And PSU | 10 | SCD | DFI |
†Mixed (Normal , oligo and asthenozoospemia) |
| Sheibak et al., 2024 | Iran | Prospective non-randomized | PSU and DGC | 100 | SCD | DFI, post-selection concentration and Post-selection progressively motility |
Normozoospermic(N = 50) Non-normozoospermic (N = 50) |
| Mirsanei et al., (34) | Iran | Prospective non-randomized | MFSS (Fertile Plus) and DGC | 25 | SCD | DFI, post-selection concentration and Post-selection progressively motility | Normozoospermic |
| Ješeta et al., (20) | Czech Republic | Prospective non-randomized | MFSS (Ca0 device by LensHooke/Bonraybio) and DSU | 68 | SCD | DFI, post-selection concentration and Post-selection progressively motility |
Normozoospermic (N = 40) Non-normozoospermic(N = 28) |
| Parrella et al., 2019 | USA | Prospective non-randomized | DGC and MFSS (Zymot) | 48 | TUNEL | DFI, post-selection concentration and Post-selection progressively motility | †Mixed |
| Traini et al., (14) | Italy | Prospective non-randomized | MFSS (Zymot), PSU and DSU | 14 | TUNEL | DFI and post-selection progressively motility | Normozoospermic |
| Yildiz et al., (35) | Turky | Prospective non-randomized | MFSS (Fertile Plus) and DGC | 20 (N = 10 for DGC and N = 10 for MFSS) | Toluidine blue staining | DFI | †Mixed |
| Vahidi et al., (15) | Iran | Prospective non-randomized | MACS, MFSS(Zymot) and PSU | 25 | SCD | DFI and post-selection progressively motility | Non-normozoospemic |
| Zini et al., (6) | Canada | Prospective non-randomized | DSU and DGC | 22 | SCSA | DFI | †Mixed (Normospermic and oligospermic) |
| Xue et al., 2014 | China | Prospective non-randomized | PSU and DGC | 118 | SCD | DFI | Teratozoospermic |
| M. Muratori et al., 2019 | Italy | Prospective non-randomized | PSU and DGC | 20with DGC and 40 with PSU | TUNEL | DFI and post-selection progressively motility | †Mixed |
| Amano et al., 2024 | Japan | Prospective non-randomized | PSU and DGC | 19 | TUNEL | DFI and post-selection progressively motility | Normozoospermic |
| Kim et al., 2017 | Korea | Prospective non-randomized | PSU and DGC | 18 | SCD | DFI | †Mixed |
| Amiri et al., 2012 | Iran | Prospective non-randomized | PSU and DGC | 35 | Comet assay | DFI and post-selection concentration | †Mixed |
| Viswambharan et al., 2020 | India | Prospective non-randomized | PSU and DGC | 32 | SCD | DFI | Normozoospermic |
| Jayaramen et al., 2012 | India | Prospective non-randomized | PSU and DGC | 51 | TUNEL | DFI, post-selection concentration and Post-selection progressively motility | Normozoospermic (n=11) Oligozoospermic(n=20) Teratozoopsermic (n=20) |
| Zhang et al., 2011 | China | Prospective non-randomized | PSU and DGC | 12 | SCD | DFI | Normozoopsermic |
| Meitei et al., 2021 | India | Prospective non-randomized | PSU and DGC | 15 | TUNEL | DFI | Normozoopsermic |
| Oguz et al., 2018 | Turkey | RCT | PSU and DGC | 65 | SCD | DFI, post-selection concentration and post-selection progressively motility | Normozoospermic (N = 34) Non-normozoospermic (N = 31) |
| Ahmad et al., 2009 | Pakistan | Prospective non-randomized | PSU and DGC | 221 | Comet assay | DFI | Normozoospermic(N = 34) Non-normozoospermic (N = 187) |
| Hardiyanto et al., 2019 | Indonesia | Prospective non-randomized | DSU and DGC | 9 | SCD | DFI | Normozoospermic |
| Le et al., 2022 | Vietnam | Prospective non-randomized | PSU and DGC | 63 | SCD | DFI and post-selection concentration | †Mixed (Normozoospermic and Oligozoospermic) |
| Ghaleno et al., 2014 | Iran | Prospective non-randomized | PSU, DSU and DGC | 28 | TUNEL | DFI, post-selection concentration and Post-selection progressively motility | †Mixed |
| Enciso et al., 2011 | Spain | Prospective non-randomized | PSU and DGC | 157 | SCD | DFI | †Mixed |
| Lachaud et al., 2004 | Spain | Prospective non-randomized | PSU and DGC | 7 | TUNEL | DFI | Normozoospermic |
| Matsuura et al., 2010 | Japan | Prospective non-randomized | DGC and DGC-PSU | 31 | SCSA | DFI | †Mixed |
| Jamil et al., 2023 | Morocco | Prospective non-randomized | DGC, DSU and DGC-PSU | 97 | TUNEL | DFI | Normozoospermic |
| Volpes et al., 2016 | Italy | Prospective non-randomized | PSU, DSU, DGC and DGC-PSU | 98 | SCD | DFI | †Mixed |
| Jackson et al., (30) | Brazil | Prospective non-randomized | PSU, DGC and DGC-PSU | 20 | SCD | DFI | Normozoospermic |
| T. Degheidy et al., 2014 | Saudi Arabia | Prospective non-randomized | DGC and DGC-MACS | 36 | TUNEL | DFI, post-selection concentration and Post-selection progressively motility | Non-normozoospermic (oligoasthenoteratospermia) |
| Hozyen et al., (36) | Egypt | RCT | DGC and DGC-MACS | 151 | TUNEL | DFI | †Mixed |
| Lee et al., 2009 | China | Prospective non-randomized | DGC and DGC-MACS | 60 | TUNEL | DFI and post-selection progressively motility | Normozoospermic |
| H. Zhang et al., 2017 | China | Prospective non-randomized | DGC and DGC-MACS | 16 | TUNEL | DFI | Non-normozoospermia (athenoteratozoospermic) |
| Cakar et al., 2016 | Turkey | Prospective non-randomized | PSU,DGC,DGC-MACS and PSU-MACS | 20 | TUNEL | DFI, post-selection concentration and Post-selection progressively motility | Normozoospermic (N = 10) Non-normozoospermic (N = 10 oligozoospermic) |
| Bucar et al., 2015 | Portugal | Prospective non-randomized | DGC-PSU and MACS-DSU | 40 | TUNEL | DFI | †Mixed (normo-, terato- and athenozoospermic |
| Nadalini et al., 2014 | Italy | Prospective non-randomized | DGC, DGC-PSU and DGC-MACS | 25 | TUNEL | DFI and post-selection progressively motility | †Mixed |
| Bibi et al., 2023 | Saudi Arabia | Prospective non-randomized | PSU, DGC, DGC-PSU and DGC-MACS | 385 | SCSA | DFI | Non-normozoospermic (Teratozoospermic) |
| Mateizel et al., 2024 | Belgium | Prospective non-randomized | PSU, DGC and MACS | 52 | TUNEL | DFI, post-selection concentration and Post-selection progressively motility | †Mixed |
| Chi et al., (13) | Korea | Prospective non-randomized | DGC, MACS and DGC-MACS | 29 | SCD | DFI | Normozoospermic |
| M Tavalaee et al., (12) | Iran | Prospective non-randomized | DGC, MACS, DGC-MACS and MACS-DGC | 15 | TUNEL | DFI | †Mixed |
| T.S.Berteli et al., 2017 | Brazil | Prospective non-randomized | DGC, MACS, DGC-MACS and MACS-DGC | 15 | TUNEL | DFI, post-selection concentration and Post-selection progressively motility | †Mixed |
*Study conducted two independent experimental phases using different semen samples and was treated as two separate comparisons in this network meta-analysis.
†
Mixed = studies that include both normozoospermic and non-normozoospermic samples without reporting sperate outcomes for each semen-quality category.
DGC, density gradient centrifugation; PSU, Pellet Swim-Up; DSU, Direct Swim-Up; DGC-PSU, Swim-Up after DGC (treated as PSU in analysis); MACS, magnetic-activated cell sorting; MACS-DGC, DGC-MACS, PSU-MACS, MACS-WSU, sequential combination methods; MFSS, Microfluidic sperm sorting; RCT, randomized controlled trial; TUNEL, Terminal deoxynucleotidyl transferase dUTP nick end labeling; SCD, sperm chromatin dispersion; SCSA, sperm chromatin structure assay; DFI, DNA fragmentation index.