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  SDF negatively impacts IVF/ICSI pregnancy outcomes
70 studies; 9363 IVF cycles; 6260 ICSI cycles; 2121 mixed IVF/ICSI cycles
By fertilization method
IVF studies: OR 1.15 (95% CI 1.05-1.27); P=0.003 ICSI studies: OR 1.12 (95% CI 1.01-1.25); P=0.025
By SDF assay type
TUNEL: OR 1.85 (95% CI 1.52-2.26); P<0.0001 SCD: OR 1.16 (95% CI 1.02-1.32); P=0.023 Comet: OR 4.15 (95% CI 3.04-5.68); P<0.0001 SCSA: OR 1.14 (95% CI 1.04-1.25); P=0.004
Simon et al., Best Pract Res Clin Obstet Gynaecol 2017 Esteves, 31
            IVF and/or ICSI failure:
Testing can provide useful prognostic information on subsequent ART cycles (grade C recommendation)
The use of testicular sperm rather than ejaculated sperm may be beneficial in men with oligozoospermia, high SDF and recurrent IVF failure (grade B–C recommendation)
Agarwal et al. Transl Androl Urol 2017 Esteves, 32
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