背景:系统评价和荟萃分析有助于塑造临床实践。然而,他们的发现有时会被差异和潜在的偏见所破坏,从而稀释了所提供证据的强度。伞状评论有助于全面评估和综合这些评论,提供了对所提供证据质量的更清晰的见解。在精子DNA碎片(SDF)和辅助受孕结果之间的关系的背景下,文献中存在分歧。一些评论提出了明确的因果关系,而其他人则呈现矛盾或不确定的结果。
目的:在这篇综述中,我们旨在综合系统综述和荟萃分析中整理的证据,总结SDF与辅助生殖技术(ART)结局的关联。
方法:预注册后(https://doi.org/10.17605/OSF。IO/6JHDP),我们对PubMed进行了全面搜索,Scopus,科克伦图书馆,WebofScience和Embase数据库。我们在没有语言或发表日期限制的情况下,对SDF和ART之间的关联进行了系统评价。
方法:评估SDF和ART结果之间关联的系统评价和荟萃分析是合格的。
方法:我们使用AMSTAR2和ROBIS评估了纳入的评论的质量,并确定估计校正覆盖面积(CCA)的评论之间的主要研究重叠程度,针对结构性缺陷进行了调整。我们评估了评估SDF与活产关联的最新评论,怀孕,流产,植入,胚芽和受精。证据的综合在所有包括的定量综合中得到了协调,用95%置信区间(95%CI)和95%预测区间(95%PI)重新估计随机效应荟萃分析中的比值比(eOR)。我们将证据强度归类为令人信服,高度暗示性,暗示,弱或不显著,根据荟萃分析,重新估计P值,总样本量,用于异质性的I2统计量,小的研究效果,过度显著性偏差和最大的研究意义。
结果:我们最初捕获并筛选了49332条记录。在排除重复和不合格的文章后,22个系统审查,其中15个是荟萃分析,被选中。22篇综述在纳入的研究中显示了中等程度的重叠(调整后的CCA9.2%)(总体n=428,有180项独特研究)。15项荟萃分析在纳入的研究中表现出高度重叠(调整后的CCA=13.6%)(总体n=274,118项独特研究)。AMSTAR2将18条评论的证据质量归类为极低,将4条评论的证据质量归类为极低。ROBIS将所有评论归类为具有很高的偏见风险。重新估计的结果表明,在一项荟萃分析中,SDF与活产的关联较弱,而在四项荟萃分析中无统计学意义。同样,SDF与怀孕的关联,流产,植入,囊胚和受精也很弱或不显着。对于不同的干预措施,高SDF与不同ART结局的关联也很弱或不显着(IVF,ICSI和IUI)和测试。
结论:本综述没有发现将SDF与ART结果联系起来的令人信服或暗示的证据。在提出任何索赔时应谨慎行事,有关自卫队的政策或建议。
BACKGROUND: Systematic reviews and meta-analyses are instrumental in shaping clinical practice. However, their findings can sometimes be marred by discrepancies and potential biases, thereby diluting the strength of the evidence presented. Umbrella reviews serve to comprehensively assess and synthesise these reviews, offering a clearer insight into the quality of the evidence presented. In the context of the relationship between sperm DNA fragmentation (SDF) and assisted conception outcomes, there is a divergence in the literature. Some reviews suggest a clear cause-and-effect linkage, whereas others present conflicting or inconclusive results.
OBJECTIVE: In this umbrella
review we aimed to synthesise the evidence collated in systematic reviews and meta-analyses summarising the association of SDF with assisted reproductive technology (ART) outcomes.
METHODS: After preregistration (https://doi.org/10.17605/OSF.IO/6JHDP), we performed a comprehensive search of the PubMed, Scopus, Cochrane Library, Web of Science and Embase databases. We conducted a search for systematic reviews on the association between SDF and ART without any restrictions on language or publication date.
METHODS: Systematic reviews and meta-analyses assessing the association between SDF and ART outcomes were eligible.
METHODS: We assessed the quality of the included reviews using AMSTAR 2 and ROBIS, and determined the degree of overlap of primary studies between reviews estimating the corrected covered area (CCA), adjusted for structural missingness. We evaluated the most recent reviews assessing the association of SDF with live birth, pregnancy, miscarriage, implantation, blastulation and fertilisation. The synthesis of evidence was harmonised across all included quantitative syntheses, re-estimating the odds ratio (eOR) in random-effects meta-analyses with 95% confidence intervals (95% CIs) and 95% prediction intervals (95% PIs). We categorised the evidence strength into convincing, highly suggestive, suggestive, weak or nonsignificant, according to the meta-analysis re-estimated P-value, total sample size, I2 statistic for heterogeneity, small study effect, excess significance bias and the largest study significance.
RESULTS: We initially captured and screened 49 332 records. After excluding duplicate and ineligible articles, 22 systematic reviews, 15 of which were meta-analyses, were selected. The 22 reviews showed a moderate degree of overlap (adjusted CCA 9.2%) in their included studies (overall n = 428, with 180 unique studies). The 15 meta-analyses exhibited a high degree of overlap (adjusted CCA = 13.6%) in their included studies (overall n = 274, with 118 unique studies). AMSTAR 2 categorised the quality of evidence in 18 reviews as critically low and the quality of evidence in four reviews as low. ROBIS categorised all the reviews as having a high risk of bias. The re-estimated results showed that the association of SDF with live birth was weak in one and nonsignificant in four meta-analyses. Similarly, the association of SDF with pregnancy, miscarriage, implantation, blastulation and fertilisation was also weak or nonsignificant. The association of high SDF with different ART outcomes was also weak or nonsignificant for different interventions (IVF, ICSI and IUI) and tests.
CONCLUSIONS: This umbrella
review did not find convincing or suggestive evidence linking SDF with ART outcomes. Caution should be exercised in making any claims, policies or recommendations concerning SDF.