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Controversy and Consensus on Indications for Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations Publisher



Agarwal A1, 2 ; Farkouh A1 ; Saleh R3 ; Hamoda TAAAM4, 5 ; Harraz AM6, 7, 8 ; Kavoussi P9 ; Arafa M10, 11, 12 ; Salvio G13 ; Rambhatla A14 ; Toprak T15 ; Gul M16 ; Phuoc NHV17, 18, 164 ; Boitrelle F19, 20 ; Birowo P21, 150 Show All Authors
Authors
  1. Agarwal A1, 2
  2. Farkouh A1
  3. Saleh R3
  4. Hamoda TAAAM4, 5
  5. Harraz AM6, 7, 8
  6. Kavoussi P9
  7. Arafa M10, 11, 12
  8. Salvio G13
  9. Rambhatla A14
  10. Toprak T15
  11. Gul M16
  12. Phuoc NHV17, 18, 164
  13. Boitrelle F19, 20
  14. Birowo P21, 150
  15. Ghayda RA22
  16. Cannarella R23
  17. Kuroda S24
  18. Durairajanayagam D25
  19. Zini A26
  20. Wyns C27
  21. Sarikaya S28
  22. Tremellen K29
  23. Mostafa T12, 148
  24. Sokolakis I30
  25. Evenson DP31
  26. Henkel R32, 33, 34
  27. Zohdy W12
  28. Chung E35
  29. Ziouziou I36
  30. Falcone M37
  31. Russo GI38
  32. Alhashimi M39, 40
  33. Calogero AE23, 151
  34. Ko E41
  35. Colpi G42, 152
  36. Lewis S43
  37. Serefoglu EC44
  38. Bahar F45, 150
  39. Martinez M46
  40. Nguyen Q47, 48, 164
  41. Ambar RF49, 50
  42. Bakircioglu ME51
  43. Kandil H52
  44. Mogharabian N53
  45. Sabbaghian M54
  46. Taniguchi H55
  47. Tsujimura A56
  48. Sajadi H54
  49. Ibrahim W57
  50. Atmoko W21
  51. Vogiatzi P58
  52. Gunes S59
  53. Gilani MAS54
  54. Roychoudhury S60
  55. Gungor ND61
  56. Hakim L62
  57. Adriansjah R63
  58. Kothari P64
  59. Jindal S65
  60. Amar E66
  61. Park HJ67, 68
  62. Long TQT69, 164
  63. Homa S70
  64. Karthikeyan VS71
  65. Zilaitiene B72
  66. Rosas IM73
  67. Marino A74
  68. Pescatori E75
  69. Ozer C76
  70. Akhavizadegan H77
  71. Garrido N78
  72. Busetto GM79, 153
  73. Adamyan A80
  74. Almarhoon M81
  75. Elbardisi H10, 11
  76. Dolati P82
  77. Darbandi M83, 84
  78. Darbandi S83, 84
  79. Balercia G13
  80. Pinggera GM85, 144
  81. Micic S86
  82. Ho CCK87, 155
  83. Moussa M88, 89, 154
  84. Preto M37
  85. Zenoagabarbarosie C90, 159
  86. Smith RP91
  87. Kosgi R92
  88. De La Rosette J93
  89. Elsakka AI94, 147
  90. Abumelha SM95
  91. Mierzwa TC96
  92. Ong TA97, 156
  93. Banihani SA98
  94. Bowa K99
  95. Fukuhara S100
  96. Boeri L101
  97. Danacioglu YO102
  98. Gokalp F103
  99. Selim OM12
  100. Cho CL104
  101. Tadros NN105
  102. Ugur MR106
  103. Ozkent MS107
  104. Chiu P104
  105. Kalkanli A108, 163
  106. Khalafalla K10, 109
  107. Vishwakarma RB110
  108. Finocchi F13, 111
  109. Andreadakis S112
  110. Giulioni C113
  111. Ceker G114, 115, 146
  112. Ceyhan E76, 146
  113. Malhotra V116
  114. Yilmaz M117
  115. Timpano M37
  116. Barrett TL118
  117. Kim SHK119, 120
  118. Ahn ST121
  119. Giacone F122
  120. Palani A123
  121. Duarsa GWK124, 149, 150
  122. Kadioglu A125, 163
  123. Gadda F101
  124. Zylbersztejn DS126
  125. Aydos K127
  126. Kulaksiz D128
  127. Gupte D129
  128. Calik G130
  129. Karna KK131
  130. Drakopoulos P132, 133
  131. Baser A134
  132. Kumar V135
  133. Molina JMC136
  134. Rajmil O137
  135. Ferreira RH138
  136. Leonardi S139
  137. Avoyan A140
  138. Sogutdelen E141
  139. Franco G142
  140. Ramsay J143
  141. Ramirez L73
  142. Shah R110
  143. Gherabi N145
  144. Kahraman O146
  145. Trotta C152
  146. Rocco L152
  147. Ngoo KS155
  148. Sallam H157, 162
  149. El Meliegy A158
  150. Alhathal N160
  151. Chien K161
  152. Lee J161
  153. Le TV164

Source: World Journal of Men's Health Published:2023


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. Copyright © 2023 Korean Society for Sexual Medicine and Andrology.
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