Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
Agarwal, Ashok Farkouh, Ala'a Saleh, Ramadan Abdel-Meguid Hamoda, Taha Abo-Almagd Harraz, Ahmed M Kavoussi, Parviz Arafa, Mohamed Salvio, Gianmaria Rambhatla, Amarnath Toprak, Tuncay
Authors
Farkouh, Ala'a
Saleh, Ramadan
Abdel-Meguid Hamoda, Taha Abo-Almagd
Harraz, Ahmed M
Kavoussi, Parviz
Arafa, Mohamed
Salvio, Gianmaria
Rambhatla, Amarnath
Toprak, Tuncay
Gül, Murat
Phuoc, Nguyen Ho Vinh
Boitrelle, Florence
Birowo, Ponco
Ghayda, Ramy Abou
Cannarella, Rossella
Kuroda, Shinnosuke
Durairajanayagam, Damayanthi
Zini, Armand
Wyns, Christine
Sarikaya, Selcuk
Tremellen, Kelton
Mostafa, Taymour
Sokolakis, Ioannis
Evenson, Donald P
Henkel, Ralf
Zohdy, Wael
Chung, Eric
Ziouziou, Imad
Falcone, Marco
Russo, Giorgio I
Al-Hashimi, Manaf
Calogero, Aldo E
Ko, Edmund
Colpi, Giovanni
Lewis, Sheena
Serefoglu, Ege Can
Bahar, Fahmi
Martinez, Marlon
Nguyen, Quang
Ambar, Rafael F
Bakircioglu, Mustafa Emre
Kandil, Hussein
Mogharabian, Nasser
Sabbaghian, Marjan
Taniguchi, Hisanori
Tsujimura, Akira
Sajadi, Hesamoddin
Ibrahim, Wael
Atmoko, Widi
Vogiatzi, Paraskevi
Gunes, Sezgin
Sadighi Gilani, Mohammad Ali
Roychoudhury, Shubhadeep
Güngör, Nur Dokuzeylül
Hakim, Lukman
Adriansjah, Ricky
Kothari, Priyank
Jindal, Sunil
Amar, Edouard
Park, Hyun Jun
Long, Tran Quang Tien
Homa, Sheryl
Karthikeyan, Vilvapathy Senguttuvan
Zilaitiene, Birute
Maldonado Rosas, Israel
Marino, Angelo
Pescatori, Edoardo
Ozer, Cevahir
Akhavizadegan, Hamed
Garrido, Nicolas
Busetto, Gian Maria
Adamyan, Aram
Al-Marhoon, Mohamed
Elbardisi, Haitham
Dolati, Parisa
Darbandi, Mahsa
Darbandi, Sara
Balercia, Giancarlo
Pinggera, Germar-Michael
Micic, Sava
Ho, Christopher Chee Kong
Moussa, Mohamad
Preto, Mirko
Zenoaga-Barbăroșie, Cătălina
Smith, Ryan P
Kosgi, Raghavender
de la Rosette, Jean
El-Sakka, Ahmed I
Abumelha, Saad Mohammed
Mierzwa, Tiago Cesar
Ong, Teng Aik
Banihani, Saleem A
Bowa, Kasonde
Fukuhara, Shinichiro
Boeri, Luca
Danacıoğlu, Yavuz Onur
Gokalp, Fatih
Selim, Osama Mohamed
Cho, Chak-Lam
Tadros, Nicholas N
Ugur, Muhammet Rasit
Ozkent, Mehmet Serkan
Chiu, Peter
Kalkanli, Arif
Khalafalla, Kareim
Vishwakarma, Ranjit B
Finocchi, Federica
Andreadakis, Sotiris
Giulioni, Carlo
Çeker, Gökhan
Ceyhan, Erman
Malhotra, Vineet
Yilmaz, Mehmet
Timpano, Massimiliano
Barrett, Trenton L
Kim, Shannon Hee Kyung
Ahn, Sun-Tae
Giacone, Filippo
Palani, Ayad
Duarsa, Gede Wirya Kusuma
Kadioglu, Ates
Gadda, Franco
Zylbersztejn, Daniel Suslik
Aydos, Kaan
Kulaksız, Deniz
Gupte, Deepak
Calik, Gokhan
Karna, Keshab Kumar
Drakopoulos, Panagiotis
Baser, Aykut
Kumar, Vijay
Molina, Juan Manuel Corral
Rajmil, Osvaldo
Ferreira, Raphael H
Leonardi, Sofia
Avoyan, Armen
Sogutdelen, Emrullah
Franco, Giorgio
Ramsay, Jonathan
Ramirez, Liliana
Shah, Rupin
Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
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Abstract
Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations.
Materials and methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus.
Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing.
Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.
Source
Agarwal A, Farkouh A, Saleh R, Abdel-Meguid Hamoda TA, Harraz AM, Kavoussi P, Arafa M, Salvio G, Rambhatla A, Toprak T, Gül M, Phuoc NHV, Boitrelle F, Birowo P, Ghayda RA, Cannarella R, Kuroda S, Durairajanayagam D, Zini A, Wyns C, Sarikaya S, Tremellen K, Mostafa T, Sokolakis I, Evenson DP, Henkel R, Zohdy W, Chung E, Ziouziou I, Falcone M, Russo GI, Al-Hashimi M, Calogero AE, Ko E, Colpi G, Lewis S, Serefoglu EC, Bahar F, Martinez M, Nguyen Q, Ambar RF, Bakircioglu ME, Kandil H, Mogharabian N, Sabbaghian M, Taniguchi H, Tsujimura A, Sajadi H, Ibrahim W, Atmoko W, Vogiatzi P, Gunes S, Sadighi Gilani MA, Roychoudhury S, Güngör ND, Hakim L, Adriansjah R, Kothari P, Jindal S, Amar E, Park HJ, Long TQT, Homa S, Karthikeyan VS, Zilaitiene B, Maldonado Rosas I, Marino A, Pescatori E, Ozer C, Akhavizadegan H, Garrido N, Busetto GM, Adamyan A, Al-Marhoon M, Elbardisi H, Dolati P, Darbandi M, Darbandi S, Balercia G, Pinggera GM, Micic S, Ho CCK, Moussa M, Preto M, Zenoaga-Barbăroșie C, Smith RP, Kosgi R, de la Rosette J, El-Sakka AI, Abumelha SM, Mierzwa TC, Ong TA, Banihani SA, Bowa K, Fukuhara S, Boeri L, Danacıoğlu YO, Gokalp F, Selim OM, Cho CL, Tadros NN, Ugur MR, Ozkent MS, Chiu P, Kalkanli A, Khalafalla K, Vishwakarma RB, Finocchi F, Andreadakis S, Giulioni C, Çeker G, Ceyhan E, Malhotra V, Yilmaz M, Timpano M, Barrett TL, Kim SHK, Ahn ST, Giacone F, Palani A, Duarsa GWK, Kadioglu A, Gadda F, Zylbersztejn DS, Aydos K, Kulaksız D, Gupte D, Calik G, Karna KK, Drakopoulos P, Baser A, Kumar V, Molina JMC, Rajmil O, Ferreira RH, Leonardi S, Avoyan A, Sogutdelen E, Franco G, Ramsay J, Ramirez L, Shah R; Global Andrology Forum. Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World J Mens Health. 2023 Jul;41(3):575-602. doi: 10.5534/wjmh.220282. Epub 2023 Apr 10. PMID: 37118960; PMCID: PMC10307662.