BackgroundSystematic reviews and meta‐analyses are instrumental in shaping clinical practice. However, their findings can sometimes be marred by discrepancies and potential biases, thereby diluting the strength of the evidence presented. Umbrella reviews serve to comprehensively assess and synthesise these reviews, offering a clearer insight into the quality of the evidence presented. In the context of the relationship between sperm DNA fragmentation (SDF) and assisted conception outcomes, there is a divergence in the literature. Some reviews suggest a clear cause‐and‐effect linkage, whereas others present conflicting or inconclusive results.ObjectivesIn this umbrella review we aimed to synthesise the evidence collated in systematic reviews and meta‐analyses summarising the association of SDF with assisted reproductive technology (ART) outcomes.Search strategyAfter preregistration (https://doi.org/10.17605/OSF.IO/6JHDP), we performed a comprehensive search of the PubMed, Scopus, Cochrane Library, Web of Science and Embase databases. We conducted a search for systematic reviews on the association between SDF and ART without any restrictions on language or publication date.Selection criteriaSystematic reviews and meta‐analyses assessing the association between SDF and ART outcomes were eligible.Data collection and analysisWe assessed the quality of the included reviews using AMSTAR 2 and ROBIS, and determined the degree of overlap of primary studies between reviews estimating the corrected covered area (CCA), adjusted for structural missingness. We evaluated the most recent reviews assessing the association of SDF with live birth, pregnancy, miscarriage, implantation, blastulation and fertilisation. The synthesis of evidence was harmonised across all included quantitative syntheses, re‐estimating the odds ratio (eOR) in random‐effects meta‐analyses with 95% confidence intervals (95% CIs) and 95% prediction intervals (95% PIs). We categorised the evidence strength into convincing, highly suggestive, suggestive, weak or nonsignificant, according to the meta‐analysis re‐estimated P‐value, total sample size, I2 statistic for heterogeneity, small study effect, excess significance bias and the largest study significance.Main resultsWe initially captured and screened 49 332 records. After excluding duplicate and ineligible articles, 22 systematic reviews, 15 of which were meta‐analyses, were selected. The 22 reviews showed a moderate degree of overlap (adjusted CCA 9.2%) in their included studies (overall n = 428, with 180 unique studies). The 15 meta‐analyses exhibited a high degree of overlap (adjusted CCA = 13.6%) in their included studies (overall n = 274, with 118 unique studies). AMSTAR 2 categorised the quality of evidence in 18 reviews as critically low and the quality of evidence in four reviews as low. ROBIS categorised all the reviews as having a high risk of bias. The re‐estimated results showed that the association of SDF with live birth was weak in one and nonsignificant in four meta‐analyses. Similarly, the association of SDF with pregnancy, miscarriage, implantation, blastulation and fertilisation was also weak or nonsignificant. The association of high SDF with different ART outcomes was also weak or nonsignificant for different interventions (IVF, ICSI and IUI) and tests.ConclusionsThis umbrella review did not find convincing or suggestive evidence linking SDF with ART outcomes. Caution should be exercised in making any claims, policies or recommendations concerning SDF.

中文翻译：

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量化精子 DNA 碎片与辅助生殖技术结果的关联：综合综述

背景系统评价和荟萃分析有助于塑造临床实践。然而，他们的研究结果有时可能会因差异和潜在偏见而受到损害，从而削弱了所提供证据的强度。伞式评论旨在全面评估和综合这些评论，从而更清晰地了解所提供证据的质量。关于精子 DNA 碎片 (SDF) 与辅助受孕结果之间的关系，文献中存在分歧。一些综述表明存在明确的因果关系，而另一些则提出了相互矛盾或不确定的结果。 目的在这篇总体综述中，我们旨在综合系统综述和荟萃分析中整理的证据，总结 SDF 与辅助生殖技术 (ART) 的关联结果.搜索策略预注册后（https://doi.org/10.17605/OSF.IO/6JHDP），我们对 PubMed、Scopus、Cochrane Library、Web of Science 和 Embase 数据库进行了全面检索。我们对 SDF 和 ART 之间的关联进行了搜索，没有任何语言或出版日期的限制。选择标准评估 SDF 和 ART 结果之间关联的系统评价和荟萃分析是合格的。数据收集和分析我们评估了研究的质量纳入了使用 AMSTAR 2 和 ROBIS 的综述，并确定了估算校正覆盖面积 (CCA) 的综述之间主要研究的重叠程度，并根据结构缺失进行了调整。我们评估了最新的评估 SDF 与活产、妊娠、流产、着床、囊胚和受精之间关系的评论。证据的综合在所有纳入的定量综合中得到了协调，在随机效应荟萃分析中重新估计了比值比 (eOR)，具有 95% 置信区间 (95% CI) 和 95% 预测区间 (95% PI)。根据荟萃分析重新估计，我们将证据强度分为令人信服的、高度暗示的、暗示的、弱的或不显着的。磷‐值，总样本量，我2主要结果我们初步捕获并筛选了49 332条记录。排除重复和不合格的文章后，选择了 22 篇系统综述，其中 15 篇为荟萃分析。这 22 篇综述显示其纳入的研究存在中等程度的重叠（调整后的 CCA 9.2%）（总体而言）n= 428，有 180 项独特的研究）。15 项荟萃分析在其纳入的研究中表现出高度重叠（调整后的 CCA = 13.6%）（总体而言）n= 274，有 118 项独特的研究）。AMSTAR 2 将 18 篇综述中的证据质量归类为极低，将 4 篇综述中的证据质量归类为低。ROBIS 将所有评论归类为具有高偏倚风险。重新估计的结果表明，SDF 与活产的关联在一项荟萃分析中较弱，在四项荟萃分析中不显着。同样，SDF 与妊娠、流产、着床、胚芽形成和受精的关联也较弱或不显着。对于不同的干预措施（IVF、ICSI 和 IUI）和测试，高 SDF 与不同 ART 结局的关联也很弱或不显着。结论本次总体综述没有发现令人信服或暗示的证据将 SDF 与 ART 结局联系起来。提出有关 SDF 的任何主张、政策或建议时应谨慎行事。