目的:最佳精子DNA完整性对受精和胚胎健康至关重要。研究表明,睾丸精子(TS),通过TESA或TESE获得,标准禁欲后,精子DNA片段(SDF)通常比射精精子低。将禁欲缩短至少于2天可能会降低SDF,为手术精子提取提供了一种侵入性较小且更具成本效益的替代方法。然而,没有研究直接比较较短禁欲与TS提取降低SDF的功效。我们的荟萃分析旨在通过在短暂禁欲期后将TS中的SDF水平与射精精子中的SDF水平进行比较来解决这一差距。
方法:16项随机对照和前瞻性观察研究的荟萃分析,包括4项关于TS的研究和12项关于短期禁欲射精的研究。荟萃分析遵循MOOSE指南,仔细检查数据库,包括Cochrane图书馆,WebofScience,Embase,MEDLINE(R),并公布至2023年11月16日。使用RevMan进行分析。使用纽卡斯尔-渥太华量表评估观察性研究的方法学质量,总体证据质量按照GRADE标准进行评估.为了比较短射精持续时间和TS(文献中没有直接比较)的SDF水平,我们分析了每种方法研究的相关数据。我们将TS组的参与者数量调整了1/3,并将每个TS研究纳入3次,与1:3的短期研究进行比较。这种方法在TS研究的荟萃分析中保持了未改变的累积受试者计数。
结果:共纳入641例患者,包括120和521名患者,在短暂禁欲期后进行TS和射精后进行SDF测量,分别。这些研究有不同的纳入标准,并非所有患者初始SDF升高。一些研究对年龄和其他人口统计学有不完整的细节。然而,93例TS患者的平均±SD年龄为38.15±5.48岁,而不是37.7±6.0岁的444名短期禁欲患者,差异无统计学意义(P=0.544)。短禁欲持续时间为1至48小时。使用了多种DNA片段化测试:在三项睾丸精子研究中进行TUNEL测定,SCD检测合二为一,在短暂的禁欲组中,四个使用的TUNEL和六个使用的SCD检测,以及每个使用SCSA和Halosperm。TS组的平均±SDSDF低于短期禁欲组(平均差异-9.48,95CI-12.45至-6.52,P<0.001,I2=85%)。敏感性分析显示,没有一项研究显着影响结果。采用等级标准,由于所获得数据的观察性,初步评估将总体证据质量归类为低.所有研究均为中等至高质量。
结论:这项研究表明,在不育症患者中,睾丸精子可能比射精精子更好地改善SDF。需要直接比较,在认为短期禁欲效果较差之前。未来的研究应该使用这两种方法直接比较生殖结果。
OBJECTIVE: Optimal sperm DNA integrity is essential for fertilization and embryo health. Research indicates that testicular sperm (TS), obtained via TESA or TESE, typically show lower sperm DNA fragmentation (SDF) than ejaculated sperm after standard abstinence. Shortening abstinence to less than 2 days might reduce SDF, offering a less invasive and more cost-effective alternative to surgical sperm retrieval. Yet, no studies have directly compared the efficacy of shorter abstinence against TS extraction for lowering SDF. Our meta-analysis aims to address this gap by comparing SDF levels in TS to those in ejaculated sperm after a short abstinence period.
METHODS: Meta-analysis of 16 randomized controlled and prospective observational studies included 4 on TS and 12 on short abstinence ejaculation. The meta-analysis followed MOOSE guidelines, scrutinizing databases including Cochrane Library, Web of Science, Embase, MEDLINE(R), and PUMBED up to November 16, 2023. The analysis was conducted using RevMan. The observational studies\' methodological quality was assessed using the Newcastle-Ottawa Scale, and the overall evidence quality was evaluated following the GRADE criteria. To compare short ejaculation duration and TS (are not directly compared in the literature) for SDF levels, we analyzed relevant data from studies of each method. We adjusted the participant numbers in the TS group by 1/3 and included each TS study three times, to perform a comparison against the short duration studies which were in a ratio of 1:3. This approach maintained an unaltered cumulative subject count for the meta-analysis of TS studies.
RESULTS: A total of 641 patients were included, comprising 120 and 521 patients with SDF measurements following TS and ejaculation after a short abstinence period, respectively. The studies had varied inclusion criteria, with not all patients having an initial elevated SDF. Some studies had incomplete details on age and other demographics. However, the mean ± SD age of 93 TS patients was 38.15 ± 5.48 years vs. 37.7 ± 6.0 years of 444 short abstinence patients, demonstrating no significant difference (P = 0.544). Short abstinence durations ranged from 1 to 48 h. Diverse DNA fragmentation tests were used: TUNEL assay in three testicular sperm studies, SCD assay in one, and in the short abstinence group, four used TUNEL and six used SCD assays, along with one each using SCSA and Halosperm. The mean ± SD SDF was lower in the TS group than in the short abstinence group (mean difference - 9.48, 95%CI - 12.45 to - 6.52, P < 0.001, I2 = 85%). Sensitivity analysis revealed that no single study significantly influenced the results. Employing the GRADE criteria, the initial assessment categorized the overall quality of evidence as low due to the observational nature of the acquired data. All studies were of medium to high quality.
CONCLUSIONS: This study suggests testicular sperm may be better than ejaculated sperm for improving SDF in infertility cases. Direct comparisons are needed, before deeming short abstinence less effective. Future research should directly compare reproductive outcomes using both methods.