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@ARTICLE{Szab:300122,
      author       = {A. Szabó and S. Váncsa and P. Hegyi and T. Kói and J.
                      Ács and R. J. Hermánné and N. Ács and T. Szarvas$^*$ and
                      P. Nyirády and Z. Kopa},
      title        = {{A}ssessing the efficacy of varicocelectomy, antioxidants,
                      {FSH} treatment, and lifestyle modifications on sperm {DNA}
                      fragmentation: a systematic review and meta-analysis.},
      journal      = {Scientific reports},
      volume       = {15},
      number       = {1},
      issn         = {2045-2322},
      address      = {[London]},
      publisher    = {Springer Nature},
      reportid     = {DKFZ-2025-00620},
      pages        = {10118},
      year         = {2025},
      abstract     = {Infertility affects $15\%$ of couples in developed
                      countries, $50\%$ accounting for male origin. In 2021, sperm
                      DNA fragmentation (SDF) testing was incorporated into male
                      fertility evaluations as an evidence-based functional test.
                      We aimed to assess the effect of interventions that could
                      potentially improve SDF. A random-effect meta-analysis was
                      performed with a systematic search in three databases.
                      Pooled mean differences (MD) with $95\%$ confidence
                      intervals (CI) were calculated. Initially, 36,531 articles
                      were found, of which 86 papers with over 8,000 patients were
                      included. Three months following varicocelectomy, the
                      decrease in SDF was $-6.74\%$ (CI: -9.40, -4.08) compared to
                      preoperative data of patients, whereas it was $-12.39\%$
                      (CI: -22.41, -2.36) after six months and $-10.06\%$ (CI:
                      -22.69, + 2.56) at twelve months. A dose-dependent effect
                      could also be observed in grade II and III varicoceles. The
                      overall SDF decrease at three months was $-4.27\%$ (CI:
                      -6.11, -2.43) for antioxidants, $-4.51\%$ (CI: -6.81, -2.20)
                      for combined antioxidant therapy and $-3.36\%$ (CI: -4.44,
                      -2.28) for monotherapy. In terms of follicle-stimulating
                      hormone treatment (FSH) at three months, the change in SDF
                      was $-6.66\%$ (CI: -9.64, -3.69). For lifestyle
                      modifications, a change of $-3.24\%$ (CI: -5.33, -1.16) was
                      observed at three months. Other interventions are
                      narratively summarized in the systematic review. Of the
                      interventions reviewed, varicocelectomy is the most
                      effective in reducing SDF at six months, FSH treatment might
                      be useful, antioxidants appear questionable, and lifestyle
                      interventions require more studies of similar designs to
                      draw firm conclusions.},
      keywords     = {Humans / Male / Varicocele: surgery / Varicocele: therapy /
                      DNA Fragmentation / Antioxidants: therapeutic use /
                      Spermatozoa / Infertility, Male: therapy / Follicle
                      Stimulating Hormone / Life Style / Treatment Outcome / DFI
                      (Other) / DNA fragmentation index (Other) / Male fertility
                      (Other) / Sperm quality (Other) / Subfertility (Other) /
                      Varicocele repair (Other) / Antioxidants (NLM Chemicals) /
                      Follicle Stimulating Hormone (NLM Chemicals)},
      cin          = {ED01},
      ddc          = {600},
      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:40128318},
      doi          = {10.1038/s41598-025-93267-z},
      url          = {https://inrepo02.dkfz.de/record/300122},
}