HSROC curve.

<p>Hierarchical summary receiver operating characteristic (HSROC) plot of sperm DNA fragmentation for prediction of (clinical) pregnancy. Each circle on the plot represents the pair of sensitivity and specificity from a study and the size of the circle is scaled according to the sample size of the study. The solid red block represents the summary sensitivity and specificity, and this summary point is surrounded by a 95% confidence region (yellow dashed line) and 95% prediction region (green dotted line). Sperm DNA fragmentation in the prediction of (clinical) pregnancy for all studies and all cut-off values of the DNA fragmentation index reported: (A) SCSA, (B) SCD test, (C) TUNEL assay and (D) alkaline Comet assay. AUC: Area under the curve; HSROC: Hierarchical summary receiver operating characteristics.</p

PCR-amplification of XMRV-gag fragments.

<p>PCR fragments were analysed on a 2% agarose-gel. (A) Using a cloned XMRV-gag fragment, the sensitivity of our nested PCR reaction amplifying a fragment of 450 bp was determined to be around 5 copies input DNA spiked in XMRV- negative seminal plasma (left panel). High input copy numbers resulted in high molecular weight products that are most likely the result of trapping of excess DNA. MS2 RNA was used as an internal control during the extraction and reverse-transcription reaction, and was amplified in all cases (right panel). (B) PCR-results for five representative patient seminal plasma samples where no XMRV-gag fragments were amplified are shown (left panel). The MS2 internal control fragment of 225 bp was always amplified (right panel), suggesting that no degradation of nucleic acid during extraction, or inhibition during amplification, had occurred.</p

Overall risk of bias in meta-analysis.

<p>This figure illustrates the overall risk of bias in the meta-analysis. The horizontal axis represents the number of studies included. The color of the bars represent the risk of bias. Yellow: high risk, blue: low risk and grey: unclear risk.</p

Flowdiagram of search and selection strategy in a systematic review and meta-analysis of sperm DNA fragmentation tests and pregnancy rates after MAR.

<p>Legend: not applicable.</p

Forest plot.

<p>Forest plot of sperm DNA fragmentation according to the DNA fragmentation index for predicting pregnancy. The plot shows study-specific estimates of sensitivity and specificity (with 95% confidence intervals). The studies are ordered according to the type of treatment: (A) SCSA, (B) SCD test, (C) TUNEL assay and (D) alkaline Comet assay. CI: confidence interval.</p

Characteristics of patients and virus detection results.

<p>*All men are currently living in The Netherlands.</p

Descriptive data of all studies for the meta-analysis regarding SCSA, SCD test, TUNEL assay and Comet assay as tools for measure sperm DNA fragmentation.

<p>Descriptive data of all studies for the meta-analysis regarding SCSA, SCD test, TUNEL assay and Comet assay as tools for measure sperm DNA fragmentation.</p

List of studies excluded from the meta-analysis.

<p>List of studies excluded from the meta-analysis.</p

Study characteristics according to QUADAS II recommendations to report the risk of bias for patient selection and the concerns for applicability of data collected in manuscripts eligible for the meta-analysis.

<p>Study characteristics according to QUADAS II recommendations to report the risk of bias for patient selection and the concerns for applicability of data collected in manuscripts eligible for the meta-analysis.</p