Abstract：
OBJECTIVE: The purpose of this narrative review is to provide a practical understanding of sperm DNA fragmentation (SDF) in the management of male infertility.
METHODS: A search for systematic reviews and meta-analyses (SRMA) on SDF between April 1st, 2018 and April 1st, 2023 was performed using PubMed and articles were selected as per their relevance to the topic. Guidelines from major societies were also reviewed. Three clinical cases are reported and discussed.
RESULTS: The search initially identified 80 articles. We selected 13 SRMAs based on their relevance to the topic. Of the 13 SRMAs, 7 evaluated the effect of SDF on assisted reproductive technology (ART) outcomes and recurrent pregnancy loss, 3 studied the effect of varicocele repair on SDF, and 3 evaluated the role of SDF involving lifestyle and environmental health factors including body mass index and male factor treatment strategies.
CONCLUSIONS: Evidence suggests that increased SDF has a negative impact on natural pregnancy and ART outcomes. SDF testing may be particularly important in the infertility evaluation of men with varicoceles, idiopathic or unexplained infertility, recurrent pregnancy loss, or previous ART failure. Further studies are needed on SDF testing and the implications it can have on male factor infertility and pregnancy outcomes as well as its implementation in the setting of ART.
METHODS: A search for systematic reviews and meta-analyses (SRMA) on SDF between April 1st, 2018 and April 1st, 2023 was performed using PubMed and articles were selected as per their relevance to the topic. Guidelines from major societies were also reviewed. Three clinical cases are reported and discussed.
RESULTS: The search initially identified 80 articles. We selected 13 SRMAs based on their relevance to the topic. Of the 13 SRMAs, 7 evaluated the effect of SDF on assisted reproductive technology (ART) outcomes and recurrent pregnancy loss, 3 studied the effect of varicocele repair on SDF, and 3 evaluated the role of SDF involving lifestyle and environmental health factors including body mass index and male factor treatment strategies.
CONCLUSIONS: Evidence suggests that increased SDF has a negative impact on natural pregnancy and ART outcomes. SDF testing may be particularly important in the infertility evaluation of men with varicoceles, idiopathic or unexplained infertility, recurrent pregnancy loss, or previous ART failure. Further studies are needed on SDF testing and the implications it can have on male factor infertility and pregnancy outcomes as well as its implementation in the setting of ART.
摘要：
目的：这篇叙述性综述的目的是提供对男性不育管理中精子DNA片段（SDF）的实际了解。
方法：搜索4月1日之间关于SDF的系统评价和荟萃分析（SRMA），2018年4月1日，2023年使用PubMed进行，并根据其与主题的相关性选择文章。还审查了主要协会的准则。报告并讨论了三例临床病例。
结果：搜索最初确定了80篇文章。我们根据与主题的相关性选择了13个SRMA。在13个SRMA中，7评估了SDF对辅助生殖技术（ART）结局和复发性妊娠丢失的影响，3．研讨了精索静脉曲张修复对SDF的影响，3评估了SDF在生活方式和环境健康因素中的作用，包括体重指数和男性因素治疗策略。
结论：证据表明，SDF增加对自然妊娠和ART结局有负面影响。SDF测试在精索静脉曲张男性的不孕症评估中可能尤为重要，特发性或无法解释的不孕症，反复妊娠丢失,或先前的ART失败。需要进一步研究SDF测试及其对男性因素不育和妊娠结局的影响，以及在ART设置中的实施。
方法：搜索4月1日之间关于SDF的系统评价和荟萃分析（SRMA），2018年4月1日，2023年使用PubMed进行，并根据其与主题的相关性选择文章。还审查了主要协会的准则。报告并讨论了三例临床病例。
结果：搜索最初确定了80篇文章。我们根据与主题的相关性选择了13个SRMA。在13个SRMA中，7评估了SDF对辅助生殖技术（ART）结局和复发性妊娠丢失的影响，3．研讨了精索静脉曲张修复对SDF的影响，3评估了SDF在生活方式和环境健康因素中的作用，包括体重指数和男性因素治疗策略。
结论：证据表明，SDF增加对自然妊娠和ART结局有负面影响。SDF测试在精索静脉曲张男性的不孕症评估中可能尤为重要，特发性或无法解释的不孕症，反复妊娠丢失,或先前的ART失败。需要进一步研究SDF测试及其对男性因素不育和妊娠结局的影响，以及在ART设置中的实施。
