Sperm DNA fragmentation and embryo aneuploidy: a comprehensive systematic review and meta-analysis

RESEARCH QUESTION: What is the association between an elevated sperm DNA fragmentation index (DFI) and the risk of embryonic aneuploidy in couples undergoing assisted reproductive technology (ART) treatment? DESIGN: This PROSPERO-registered systematic review and meta-analysis (CRD420251067930) searched PubMed, Embase, Cochrane Library and Web of Science from inception to 10 July 2025 for observational studies. Studies were included if they reported on couples undergoing ART treatment with sperm DFI testing and preimplantation genetic testing. Heterogeneity was explored via pre-specified subgroup analyses. Robustness was evaluated through sensitivity analyses (leave-one-out method) and assessment of publication bias using funnel plots and Egger's test. RESULTS: From 601 records, 11 studies were systematically reviewed. Meta-analysis of seven studies (3563 embryos) revealed a significant, albeit modest, positive association (pooled RR = 1.16, 95% CI 1.03 to 1.31), with considerable heterogeneity (I² = 55%). The significance of this association varied across subgroups. No significant publication bias was detected, and sensitivity analyses confirmed the robustness of the primary finding. CONCLUSIONS: Current evidence, derived solely from retrospective studies, establishes a modest link but is insufficient to recommend sperm DFI testing as an independent guide for clinical decisions, highlighting the need for prospective validation.