Microfluidic sorting selects sperm for clinical use with reduced DNA damage compared to density gradient centrifugation in split semen samples

included. The included studies generally scored 6 or more on the Newcastle-Ottawa Quality Assessment Scale. The primary meta-analysis of 26 studies comprising 8173 couples showed a significantly higher miscarriage rate in the high DFI group than in the low DFI group [RR1⁄41.76(1.31,2.37), P1⁄40.002<0.01]. The meta-analysis of 8 studies comprising 17631 embryos revealed a significantly lower good quality embryo rate [RR1⁄40.64(0.61, 0.67), P<0.00001]. The meta-analysis 13 studies comprising 3496 couples showed that the high DFI group had a significantly lower clinical pregnancy rate than the low DFI group [RR1⁄40.77(0.69, 0.85), P<0.0001]. CONCLUSIONS:With such a large number of samples supported, we can safely conclude that high DFI does adversely affect ART outcome, although the mechanism involved remains to be determined. More well-designed studies exploring the association between DFI and ARToutcome are desired, and a standard threshold of DNA damage needs to be established for various DNA assays in routine clinical use.