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. 2026 Jul 13;17:1817587. doi: 10.3389/fendo.2026.1817587

Table 4.

Pairwise and network meta-analysis of sperm DNA fragmentation using different preparation techniques.

Outcome Comparisons Pairwise meta-analysis Network meta-analysis SMD (95% CI)
No. of studies SMD (95% CI)
Sperm DNA fragmentation DGC as a reference
PSU 21 ─0.97 (─1.83, ─0.12) ─0.81 (─1.28, ─0.34)
DSU 5 ─1.37 (─2.63, ─0.12) ─1.38 (─2.20, ─0.55)
DGC-PSU 6 ─0.94 (─1.68, ─0.21) ─1.27 (─2.09, ─0.45)
DGC-MACS 10 ─0.61 (─0.98, ─0.23) ─0.92 (─1.60, ─0.25)
MFSS 5 ─3.53 (─9.72, 2.65) ─2.64 (─3.53, ─1.75)
MACS *NA *NA ─0.59 (─1.51, 0.33)
MACS-DGC *NA *NA ─1.53 (─2.93, ─0.12)
MACS-DSU *NA *NA ─1.20 (─3.63, 1.22)
PSU-MACS *NA *NA ─1.01 (─2.90,0.87)
PSU as a reference
DSU 3 ─0.25 (─4.17,3.67) 0.51 (─5.26, 6.28)
DGC-PSU 3 ─0.59 (─2.84, 1.67) 1.02 (─4.57, 6.62)
MFSS 4 ─12.66 (─50.21, 24.90) ─2.06 (─3.26, ─0.86)
DSU as a reference
MFSS 2 *NA ─1.27 (─2.32, ─0.21)

*NA indicates comparisons for which direct evidence was unavailable or not performed. 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; MD, mean difference; CI, confidential interval.