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This phenomenon may be attributed to two primary factors: first, the high quality sperm obtained through PureSperm density gradient centrifugation may play a crucial role, which has been demonstrated to significantly reduce apoptotic sperm and cellular debris while maintaining a viable sperm recovery rate exceeding 85% [47], second, the supplementation of Vit A and Lup may effectively enhance sperm motility, plasma membrane integrity, acrosome integrity, and antioxidant capacity while reducing sperm apoptosis levels
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But the strongest results came from retrospective analyses with major potential for residual confounding, and the signal weakened in the comparison against SGLT2 inhibitors
