Table 3.
GRADE/CINeMA summary table for key comparisons evaluating on sperm DNA fragmentation and clinical pregnancy outcome.
| Outcome | Comparisons | Number of studies | Within-study bias | Reporting bias | Indirectness | Imprecision | Heterogeneity | Incoherence | NMA quality |
|---|---|---|---|---|---|---|---|---|---|
| Sperm DNA fragmentation | MFSS vs DGC | 7 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | Moderate |
| MFSS vs PSU | 5 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | Low | |
| MFSS vs DGC-PSU | Indirect* | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊙⊙ | Very low | |
| MFSS vs MACS | 1 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | Low | |
| MFSS vs DGC-MACS | Indirect* | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊙⊙ | Very low | |
| MACS-DGC vs DGC | 2 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | Low | |
| MACS vs DGC | 4 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | Low | |
| DGC-MACS vs DGC | 10 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊕⊙ | Low | |
| DSU vs DGC | 6 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | Low | |
| PSU vs DGC | 21 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | Low | |
| DGC-PSU vs DGC | 6 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | Low | |
| Clinical pregnancy outcome | DGC vs combination of MACS and DGC | 4 | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | Low |
| MFSS vs DGC | 3 | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | Low | |
| DGC vs SU | 1 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | Very low | |
| MFSS vs SU | 2 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | Low | |
| MFSS vs combination of MACS and DGC | 0 | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊙⊙ | ⊕⊕⊕⊕ | Very low | |
| combination of MACS and DGC vs SU | 0 | ⊕⊕⊕⊕ | ⊕⊕⊕⊙ | ⊕⊕⊕⊙ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | ⊕⊕⊕⊕ | Low |
This table summarize the certainty of evidence for key comparisons for DNA fragmentation and clinical pregnancy outcome using the GRADE framework. Each domain is rated according to CINeMA’s judgements (no concerns, some concerns, major concerns) and translated into GRADE symbols: ⊕⊕⊕⊕ — no concerns (no downgrade), ⊕⊕⊕⊙ —some concerns (downgrade one level) and ⊕⊕⊙⊙ —major concerns (downgraded two levels).
*Indirect means when the network estimate is derived exclusively from indirect evidence. The final NMA quality reflects CINeMA’s overall confidence in the network estimate.
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; GRADE, Grading of Recommendations Assessment, Development and Evaluation; CINeMA, Confidence in Network Meta-Analysis.