P-004 Impact of short abstinence versus testicular sperm on sperm DNA fragmentation: a systematic review and meta-analysis of prospective studies
Bibliographic record
Abstract
Abstract Study question Does testicular sperm result in lower sperm DNA fragmentation (SDF) compared to ejaculated sperm after short abstinence? Summary answer Testicular sperm exhibited significantly lower SDF than ejaculated sperm post-short abstinence. What is known already Optimal sperm DNA integrity is vital for fertilization and embryo health. Research shows testicular sperm typically exhibit lower SDF than ejaculated sperm with a standard abstinence period in the same individuals. Additionally, evidence indicates reducing abstinence to < 2 days may decrease SDF, presenting a simpler, more cost-effective strategy than surgical retrieval. Yet, no studies have directly compared the efficacy of shorter abstinence against testicular sperm extraction for lowering SDF. Study design, size, duration Meta-analysis of 16 randomized controlled and prospective observational studies including four on testicular sperm (TESA or TESE, called TS) and twelve 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. Participants/materials, setting, methods To compare short ejaculation duration and TESA (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 3 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. Main results and the role of chance 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 hours. Diverse DNA fragmentation tests were used: TUNEL assay in three testicular sperm studies, SCD assay in one, and in the short abstinence group, 4 used TUNEL and 6 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. Limitations, reasons for caution Our meta-analysis, the first to compare two distinct methods for reducing SDF, while navigating through challenges of diverse study designs, variable patient characteristics, and differing DNA fragmentation tests. Despite these limitations, it marks a significant step in a field where direct, head-to-head comparisons have been absent, offering crucial insights. Wider implications of the findings 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. Trial registration number not applicable
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.036 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.044 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".