TY - JOUR
T1 - Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility
T2 - A Global Survey, Current Guidelines, and Expert Recommendations
AU - Global Andrology Forum
AU - Agarwal, Ashok
AU - Farkouh, Ala'a
AU - Saleh, Ramadan
AU - Hamoda, Taha Abo Almagd Abdel Meguid
AU - Harraz, Ahmed M.
AU - Kavoussi, Parviz
AU - Arafa, Mohamed
AU - Salvio, Gianmaria
AU - Rambhatla, Amarnath
AU - Toprak, Tuncay
AU - Gül, Murat
AU - Phuoc, Nguyen Ho Vinh
AU - Boitrelle, Florence
AU - Birowo, Ponco
AU - Ghayda, Ramy Abou
AU - Cannarella, Rossella
AU - Kuroda, Shinnosuke
AU - Durairajanayagam, Damayanthi
AU - Zini, Armand
AU - Wyns, Christine
AU - Sarikaya, Selcuk
AU - Tremellen, Kelton
AU - Mostafa, Taymour
AU - Sokolakis, Ioannis
AU - Evenson, Donald P.
AU - Henkel, Ralf
AU - Zohdy, Wael
AU - Chung, Eric
AU - Ziouziou, Imad
AU - Falcone, Marco
AU - Russo, Giorgio I.
AU - Al-Hashimi, Manaf
AU - Calogero, Aldo E.
AU - Ko, Edmund
AU - Colpi, Giovanni
AU - Lewis, Sheena
AU - Serefoglu, Ege Can
AU - Bahar, Fahmi
AU - Martinez, Marlon
AU - Nguyen, Quang
AU - Ambar, Rafael F.
AU - Bakircioglu, Mustafa Emre
AU - Kandil, Hussein
AU - Mogharabian, Nasser
AU - Sabbaghian, Marjan
AU - Taniguchi, Hisanori
AU - Tsujimura, Akira
AU - Sajadi, Hesamoddin
AU - Ibrahim, Wael
AU - Atmoko, Widi
N1 - Publisher Copyright:
Copyright © 2023 Korean Society for Sexual Medicine and Andrology.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Delphi method
KW - DNA fragmentation
KW - Male infertility
KW - Practice guidelines
KW - Sperm
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=85159180302&partnerID=8YFLogxK
U2 - 10.5534/wjmh.220282
DO - 10.5534/wjmh.220282
M3 - Article
AN - SCOPUS:85159180302
SN - 2287-4208
VL - 41
JO - World Journal of Men's Health
JF - World Journal of Men's Health
ER -