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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
Show Affiliations
Authors Affiliations
  1. 1. Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, United States
  2. 2. Cleveland Clinic Foundation, Cleveland, OH, United States
  3. 3. Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
  4. 4. Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
  5. 5. Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
  6. 6. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
  7. 7. Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
  8. 8. Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
  9. 9. Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, United States
  10. 10. Department of Urology, Hamad Medical Corporation, Doha, Qatar
  11. 11. Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
  12. 12. Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
  13. 13. Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
  14. 14. Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, United States
  15. 15. Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
  16. 16. Department of Urology, Selcuk University School of Medicine, Konya, Turkey
  17. 17. Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Viet Nam
  18. 18. Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
  19. 19. Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
  20. 20. Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
  21. 21. Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  22. 22. Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, United States
  23. 23. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  24. 24. Department of Urology, Cleveland Clinic, Cleveland, OH, United States
  25. 25. Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
  26. 26. Department of Surgery, McGill University, Montreal, QC, Canada
  27. 27. Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium
  28. 28. Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
  29. 29. Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia
  30. 30. Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
  31. 31. SCSA Diagnostics, Brookings, SD, United States
  32. 32. Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
  33. 33. Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
  34. 34. LogixX Pharma, Theale, Berkshire, United Kingdom
  35. 35. Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
  36. 36. Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
  37. 37. Department of Urology, Molinette Hospital, A.O.U. Citta della Salute e della Scienza, University of Turin, Torino, Italy
  38. 38. Urology Section, University of Catania, Catania, Italy
  39. 39. Department of Urology, Burjeel Hospital, Abu Dhabi, United Arab Emirates
  40. 40. Department of Urology, Clinical Urology, Khalifa University, College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
  41. 41. Department of Urology, Loma Linda University Health, Loma Linda, CA, United States
  42. 42. Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
  43. 43. Examen Lab Ltd., Northern Ireland, United Kingdom
  44. 44. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
  45. 45. Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
  46. 46. Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
  47. 47. Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Viet Nam
  48. 48. Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
  49. 49. Department of Urology, Centro Universitario em Saude do ABC, Santo Andre, Brazil
  50. 50. Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil
  51. 51. SENSART Clinic, Urology, Fulya, Istanbul, Turkey
  52. 52. Fakih IVF Fertility Center, Abu Dhabi, United Arab Emirates
  53. 53. Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
  54. 54. Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  55. 55. Department of Urology and Andrology, Kansai Medical University, Osaka, Hirakata, Japan
  56. 56. Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
  57. 57. Department of Obstetrics Gynaecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt
  58. 58. Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece
  59. 59. Department of Medical Biology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
  60. 60. Department of Life Science and Bioinformatics, Assam University, Silchar, India
  61. 61. Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
  62. 62. Department of Urology, Faculty of Medicine Universitas Airlangga, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
  63. 63. Department of Urology, Faculty of Medicine Universitas Padjajaran, Hasan Sadikin General Hospital, Bandung, Indonesia
  64. 64. Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
  65. 65. Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
  66. 66. Department of Urology, American Hospital of Paris, Paris, France
  67. 67. Department of Urology, Pusan National University School of Medicine, Busan, South Korea
  68. 68. Medical Research Institute of Pusan National University Hospital, Busan, South Korea
  69. 69. Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Viet Nam
  70. 70. Department of Biosciences, University of Kent, Canterbury, United Kingdom
  71. 71. Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India
  72. 72. Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
  73. 73. IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
  74. 74. Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
  75. 75. Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
  76. 76. Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
  77. 77. Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  78. 78. IVI Foundation, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), Valencia, Spain
  79. 79. Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
  80. 80. IVF Department, Astghik Medical Center, Yerevan, Armenia
  81. 81. Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Oman
  82. 82. Department of Animal Science, Faculty of Agriculture, University of Shiraz, Iran
  83. 83. Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
  84. 84. Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
  85. 85. Department of Urology, Innsbruck Medical University, Innsbruck, Austria
  86. 86. Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
  87. 87. Department of Surgery, School of Medicine, Taylor's University, Selangor, Subang Jaya, Malaysia
  88. 88. Department of Urology, Lebanese University, Beirut, Lebanon
  89. 89. Department of Urology, Al Zahraa Hospital, UMC, Lebanon
  90. 90. Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
  91. 91. Department of Urology, University of Virginia School of Medicine, Virginia, United States
  92. 92. Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India
  93. 93. Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
  94. 94. Department of Urology, Suez Canal University, Ismailia, Egypt
  95. 95. Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
  96. 96. Androlab, Fertility Clinic, PR, Curitiba, Brazil
  97. 97. Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
  98. 98. Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
  99. 99. Department of Urology, University of Lusaka, Lusaka, Zambia
  100. 100. Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
  101. 101. Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
  102. 102. Department of Urology, University of Health Science Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
  103. 103. Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey
  104. 104. S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
  105. 105. Division of Urology, Southern Illinois University, Springfield, IL, United States
  106. 106. IVF Michigan, Bloomfield Hills, MI, United States
  107. 107. Department of Urology, Konya City Hospital, Konya, Turkey
  108. 108. Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
  109. 109. Department of Urology, University of Illinois, Chicago, IL, United States
  110. 110. Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
  111. 111. Unit of Andrology and Reproductive Medicine, University of Padua, Padua, Italy
  112. 112. Private Practice, Thessaloniki, Greece
  113. 113. Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
  114. 114. Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
  115. 115. Department of Embryology and Histology, Zonguldak Bulent Ecevit University Institute of Health Sciences, Zonguldak, Turkey
  116. 116. Department of Urology, SCM Clinic and Hospital, New Delhi, India
  117. 117. Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
  118. 118. Perth Urology Clinic, Perth, WA, Australia
  119. 119. IVF Australia, Sydney, Australia
  120. 120. Macquarie School of Medicine, Macquaire University, Sydney, Australia
  121. 121. Department of Urology, Korea University College of Medicine, Seoul, South Korea
  122. 122. Centro HERA, Unita di Medicina della Riproduzione, Sant'Agata Li Battiati, Catania, Italy
  123. 123. Research Centre, University of Garmian, Kalar, Iraq
  124. 124. Department of Urology, Udayana University, Denpasar, Indonesia
  125. 125. Section of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey
  126. 126. Fleury Group and Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  127. 127. Department of Urology, Ankara University, Ankara, Turkey
  128. 128. Department of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey
  129. 129. Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India
  130. 130. Department of Urology, Istanbul Medipol University, Istanbul, Turkey
  131. 131. Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, United States
  132. 132. Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
  133. 133. IVF Athens, Athens, Greece
  134. 134. Department of Urology, Bandirma Onyedi Eylul University, Balikesir, Turkey
  135. 135. Department of Microbiology, Kurukshetra University, Kurukshetra, India
  136. 136. Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain
  137. 137. Department of Andrology, Fundacio Puigvert, Barcelona, Spain
  138. 138. Department of Urology, Santa Casa de Ribeirao Preto, Sao Paulo, Brazil
  139. 139. Central Laboratory, Hospital Publico Materno Infantil de Salta, Salta, Argentina
  140. 140. Urology Department, Astghik Medical Center, Yerevan, Armenia
  141. 141. Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey
  142. 142. Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
  143. 143. Department of Andrology, Hammersmith Hospital, London, United Kingdom
  144. 144. AK Andrologie und Sexuelle Funktionsstorungen as Part of the Osterreichische Gesellschaft fur Urologie und Andrologie, Austria
  145. 145. Algerian Association of Urology, Algeria
  146. 146. Andrology Working Group, Society of Urologic Surgery in Turkey, Turkey
  147. 147. Egyptian Society for Sexual Medicine & Surgery, Egypt
  148. 148. Egyptian Society of Andrology, Egypt
  149. 149. Indonesian Society of Andrological Urology, Indonesia
  150. 150. Indonesian Urological Association, Indonesia
  151. 151. Italian Society of Andrology and Sexual Medicine, Italy
  152. 152. Italian Society of Human Reproduction, Italy
  153. 153. Italian Society of Urology, Italy
  154. 154. Lebanese Society of Urology, Lebanon
  155. 155. Malaysian Society of Andrology and the Study of the Aging Male, Malaysia
  156. 156. Malaysian Urological Association, Malaysia
  157. 157. Mediterranean Society for Reproductive Medicine, Egypt
  158. 158. Middle East Society for Sexual Medicine, Egypt
  159. 159. Romanian Association for Sexual Medicine, Romania
  160. 160. Saudi Andrology Group, Saudi Arabia
  161. 161. Society for Mens Health Singapore, Singapore
  162. 162. Society of Egyptian Fellows, The Royal College of Obstetricians and Gynecologists, Egypt
  163. 163. Turkish Association of Urology, Turkey
  164. 164. Vietnam Society of Sexual Medicine, Viet Nam

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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