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@ARTICLE{Szab:210388,
      author       = {A. Szabó and S. Váncsa and P. Hegyi and A. Váradi and A.
                      Forintos and T. Filipov and J. Ács and N. Ács and T.
                      Szarvas$^*$ and P. Nyirády and Z. Kopa},
      title        = {{L}ifestyle-, environmental-, and additional health factors
                      associated with an increased sperm {DNA} fragmentation: a
                      systematic review and meta-analysis.},
      journal      = {Reproductive biology and endocrinology},
      volume       = {21},
      number       = {1},
      issn         = {1477-7827},
      address      = {London},
      publisher    = {Biomed Central},
      reportid     = {DKFZ-2023-00117},
      pages        = {5},
      year         = {2023},
      abstract     = {Infertility affects one in every six couples in developed
                      countries, and approximately $50\%$ is of male origin. In
                      2021, sperm DNA fragmentation (SDF) testing became an
                      evidence-based test for fertility evaluations depicting
                      fertility more clearly than standard semen parameters.
                      Therefore, we aimed to summarize the potential prognostic
                      factors of a higher SDF.We conducted a systematic search in
                      three medical databases and included studies investigating
                      any risk factors for SDF values. We calculated mean
                      differences (MD) in SDF with $95\%$ confidence interval (CI)
                      for exposed and non-exposed individuals.We included 190
                      studies in our analysis. In the group of associated health
                      conditions, varicocele (MD = $13.62\%,$ CI: 9.39-17.84) and
                      impaired glucose tolerance (MD = $13.75\%,$ CI: 6.99-20.51)
                      had the most significant increase in SDF. Among
                      malignancies, testicular tumors had the highest impact, with
                      a maximum of MD = $11.3\%$ (CI: 7.84-14.76). Among
                      infections, the overall effects of both Chlamydia and HPV
                      were negligible. Of lifestyle factors, smoking had the most
                      disruptive effect on SDF - an increase of $9.19\%$ (CI:
                      4.33-14.06). Different periods of sexual abstinence did not
                      show significant variations in SDF values. Age seemed to
                      have a more drastic effect on SDF from age 50 onwards, with
                      a mean difference of $12.58\%$ (CI: 7.31-17.86). Pollution
                      also had a detrimental effect - $9.68\%$ (CI: 6.85-12.52).Of
                      the above risk factors, varicocele, impaired glucose
                      tolerance, testicular tumors, smoking, pollution, and
                      paternal age of over 50 were associated with the highest
                      SDF.CRD42021282533.},
      subtyp        = {Review Article},
      keywords     = {DFI (Other) / DNA fragmentation index (Other) / Infertility
                      (Other) / Male fertility (Other) / Prognostic factors
                      (Other) / Reproductive medicine (Other) / SDF (Other) /
                      Sperm DNA fragmentation (Other) / Sperm quality (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36653793},
      doi          = {10.1186/s12958-023-01054-0},
      url          = {https://inrepo02.dkfz.de/record/210388},
}