Effect of sperm DNA fragmentation on embryo euploidy rate in assisted reproductive technologies: a systematic review...

To quantitatively evaluate the association between sperm DNA fragmentation (SDF) and embryo euploidy rates in assisted reproductive technology (ART) cycles through a systematic review and meta-analysis.

Following the PRISMA 2020 guidelines, a comprehensive search of PubMed, Web of Science, Embase, Scopus, and the Cochrane Library was conducted from inception to August 5, 2025. Eligible studies included infertile couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), in which SDF was assessed using validated assays and embryo euploidy was determined via preimplantation genetic testing for aneuploidy (PGT-A). The Newcastle-Ottawa Scale was used for quality assessment. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models based on heterogeneity.

Six studies involving 1,516 ART cycles met the inclusion criteria. All studies measured SDF using the sperm chromatin structure assay (SCSA), with cutoff values ranging from 15 to 30%. Embryo chromosomal status was evaluated at the blastocyst stage using PGT-A platforms, such as next-generation sequencing (NGS), array comparative genomic hybridization (aCGH), or single nucleotide polymorphism (SNP) arrays, with whole genome amplification (WGA) applied as a pre-analytical step rather than a detection method. Meta-analysis revealed no significant association between high SDF and embryo euploidy when using the 15% cutoff (pooled OR = 0.897; 95% CI 0.741-1.085; I² = 0.0%). At the 30% cutoff, high SDF (DFI ≥ 30%) was associated with lower embryo euploidy rates (pooled OR = 0.742; 95% CI 0.558-0.988; I² = 62.2%).

Elevated SDF, particularly above 30%, is associated with a reduced likelihood of obtaining euploid embryos in ART cycles, suggesting a potential threshold-dependent effect of sperm DNA integrity on embryo chromosomal normality. These findings support the integration of SDF assessment into the evaluation of selected couples, especially in cases of recurrent ART failure or advanced maternal age. Further prospective studies with standardized SDF protocols and uniform PGT-A methods are warranted to validate these results.