Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional...

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Published in:World Journal of Men's Health
Main Author: Farkouh A.; Agarwal A.; Abdel-Meguid Hamoda T.A.A.; Kavoussi P.; Saleh R.; Zini A.; Arafa M.; Harraz A.M.; Gul M.; Karthikeyan V.S.; Durairajanayagam D.; Rambhatla A.; Boitrelle F.; Chung E.; Birowo P.; Toprak T.; Ghayda R.A.; Cannarella R.; Phuoc N.H.V.; Dimitriadis F.; Russo G.I.; Sokolakis I.; Mostafa T.; Makarounis K.; Ziouziou I.; Kuroda S.; Bendayan M.; Kaiyal R.S.; Japari A.; Simopoulou M.; Rocco L.; Garrido N.; Gherabi N.; Bocu K.; Kahraman O.; Le T.V.; Wyns C.; Tremellen K.; Sarikaya S.; Lewis S.; Evenson D.P.; Ko E.; Calogero A.E.; Bahar F.; Martinez M.; Crafa A.; Nguyen Q.; Ambar R.F.; Colpi G.; Bakircioglu M.E.; Henkel R.; Kandil H.; Serefoglu E.C.; Alarbid A.; Tsujimura A.; Kheradmand A.; Anagnostopoulou C.; Marino A.; Adamyan A.; Zilaitiene B.; Ozer C.; Pescatori E.; Vogiatzi P.; Busetto G.M.; Balercia G.; Elbardisi H.; Akhavizadegan H.; Sajadi H.; Taniguchi H.; Park H.J.; Rosas I.M.; Al-Marhoon M.; Gilani M.A.S.; Alhathal N.; Pinggera G.-M.; Kothari P.; Mogharabian N.; Micic S.; Homa S.; Darbandi S.; Long T.Q.T.; Zohdy W.; Atmoko W.; Sabbaghian M.; Ibrahim W.; Smith R.P.; Ho C.C.K.; De La Rosette J.; El-Sakka A.I.; Preto M.; Zenoaga-Barbǎroşie C.; Abumelha S.M.; Baser A.; Aydos K.; Ramirez-Dominguez L.; Kumar V.; Ong T.A.; Mierzwa T.C.; Adriansjah R.; Banihani S.A.; Bowa K.; Fukuhara S.; Peña M.R.R.; Moussa M.; Çaǧin Ari U.; Cho C.-L.; Tadros N.N.; Ugur M.R.; Amar E.; Falcone M.; Santer F.R.; Kalkanli A.; Karna K.K.; Khalafalla K.; Vishwakarma R.B.; Finocchi F.; Giulioni C.; Ceyhan E.; Çeker G.; Yazbeck C.; Rajmil O.; Yilmaz M.; Altay B.; Barrett T.L.; Ngoo K.S.; Roychoudhury S.; Salvio G.; Lin H.; Kadioglu A.; Timpano M.; Avidor-Reiss T.; Hakim L.; Sindhwani P.; Franco G.; Singh R.; Giacone F.; Ruzaev M.; Kosgi R.; Sofikitis N.; Palani A.; Calik G.; Kulaksiz D.; Jezek D.; Hashmi M.A.; Drakopoulos P.; Omran H.; Leonardi S.; Celik-Ozenci C.; Güngör N.D.; Ramsay J.; Amano T.; Sogutdelen E.; Duarsa G.W.K.; Chiba K.; Jindal S.; Savira M.; Boeri L.; Borges E.; Gupte D.; Gokalp F.; Hebrard G.H.; Minhas S.; Shah R.
Format: Article
Language:English
Published: Korean Society for Sexual Medicine and Andrology 2023
Online Access:https://www.scopus.com/inward/record.uri?eid=2-s2.0-85163745039&doi=10.5534%2fwjmh.230008&partnerID=40&md5=3a54566996edea258627e4326f5846eb
id 2-s2.0-85163745039
spelling 2-s2.0-85163745039
Farkouh A.; Agarwal A.; Abdel-Meguid Hamoda T.A.A.; Kavoussi P.; Saleh R.; Zini A.; Arafa M.; Harraz A.M.; Gul M.; Karthikeyan V.S.; Durairajanayagam D.; Rambhatla A.; Boitrelle F.; Chung E.; Birowo P.; Toprak T.; Ghayda R.A.; Cannarella R.; Phuoc N.H.V.; Dimitriadis F.; Russo G.I.; Sokolakis I.; Mostafa T.; Makarounis K.; Ziouziou I.; Kuroda S.; Bendayan M.; Kaiyal R.S.; Japari A.; Simopoulou M.; Rocco L.; Garrido N.; Gherabi N.; Bocu K.; Kahraman O.; Le T.V.; Wyns C.; Tremellen K.; Sarikaya S.; Lewis S.; Evenson D.P.; Ko E.; Calogero A.E.; Bahar F.; Martinez M.; Crafa A.; Nguyen Q.; Ambar R.F.; Colpi G.; Bakircioglu M.E.; Henkel R.; Kandil H.; Serefoglu E.C.; Alarbid A.; Tsujimura A.; Kheradmand A.; Anagnostopoulou C.; Marino A.; Adamyan A.; Zilaitiene B.; Ozer C.; Pescatori E.; Vogiatzi P.; Busetto G.M.; Balercia G.; Elbardisi H.; Akhavizadegan H.; Sajadi H.; Taniguchi H.; Park H.J.; Rosas I.M.; Al-Marhoon M.; Gilani M.A.S.; Alhathal N.; Pinggera G.-M.; Kothari P.; Mogharabian N.; Micic S.; Homa S.; Darbandi S.; Long T.Q.T.; Zohdy W.; Atmoko W.; Sabbaghian M.; Ibrahim W.; Smith R.P.; Ho C.C.K.; De La Rosette J.; El-Sakka A.I.; Preto M.; Zenoaga-Barbǎroşie C.; Abumelha S.M.; Baser A.; Aydos K.; Ramirez-Dominguez L.; Kumar V.; Ong T.A.; Mierzwa T.C.; Adriansjah R.; Banihani S.A.; Bowa K.; Fukuhara S.; Peña M.R.R.; Moussa M.; Çaǧin Ari U.; Cho C.-L.; Tadros N.N.; Ugur M.R.; Amar E.; Falcone M.; Santer F.R.; Kalkanli A.; Karna K.K.; Khalafalla K.; Vishwakarma R.B.; Finocchi F.; Giulioni C.; Ceyhan E.; Çeker G.; Yazbeck C.; Rajmil O.; Yilmaz M.; Altay B.; Barrett T.L.; Ngoo K.S.; Roychoudhury S.; Salvio G.; Lin H.; Kadioglu A.; Timpano M.; Avidor-Reiss T.; Hakim L.; Sindhwani P.; Franco G.; Singh R.; Giacone F.; Ruzaev M.; Kosgi R.; Sofikitis N.; Palani A.; Calik G.; Kulaksiz D.; Jezek D.; Hashmi M.A.; Drakopoulos P.; Omran H.; Leonardi S.; Celik-Ozenci C.; Güngör N.D.; Ramsay J.; Amano T.; Sogutdelen E.; Duarsa G.W.K.; Chiba K.; Jindal S.; Savira M.; Boeri L.; Borges E.; Gupte D.; Gokalp F.; Hebrard G.H.; Minhas S.; Shah R.
Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
2023
World Journal of Men's Health
41
4
10.5534/wjmh.230008
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85163745039&doi=10.5534%2fwjmh.230008&partnerID=40&md5=3a54566996edea258627e4326f5846eb
Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians. © The Author(s), 2023.
Korean Society for Sexual Medicine and Andrology
22874208
English
Article
All Open Access; Gold Open Access
author Farkouh A.; Agarwal A.; Abdel-Meguid Hamoda T.A.A.; Kavoussi P.; Saleh R.; Zini A.; Arafa M.; Harraz A.M.; Gul M.; Karthikeyan V.S.; Durairajanayagam D.; Rambhatla A.; Boitrelle F.; Chung E.; Birowo P.; Toprak T.; Ghayda R.A.; Cannarella R.; Phuoc N.H.V.; Dimitriadis F.; Russo G.I.; Sokolakis I.; Mostafa T.; Makarounis K.; Ziouziou I.; Kuroda S.; Bendayan M.; Kaiyal R.S.; Japari A.; Simopoulou M.; Rocco L.; Garrido N.; Gherabi N.; Bocu K.; Kahraman O.; Le T.V.; Wyns C.; Tremellen K.; Sarikaya S.; Lewis S.; Evenson D.P.; Ko E.; Calogero A.E.; Bahar F.; Martinez M.; Crafa A.; Nguyen Q.; Ambar R.F.; Colpi G.; Bakircioglu M.E.; Henkel R.; Kandil H.; Serefoglu E.C.; Alarbid A.; Tsujimura A.; Kheradmand A.; Anagnostopoulou C.; Marino A.; Adamyan A.; Zilaitiene B.; Ozer C.; Pescatori E.; Vogiatzi P.; Busetto G.M.; Balercia G.; Elbardisi H.; Akhavizadegan H.; Sajadi H.; Taniguchi H.; Park H.J.; Rosas I.M.; Al-Marhoon M.; Gilani M.A.S.; Alhathal N.; Pinggera G.-M.; Kothari P.; Mogharabian N.; Micic S.; Homa S.; Darbandi S.; Long T.Q.T.; Zohdy W.; Atmoko W.; Sabbaghian M.; Ibrahim W.; Smith R.P.; Ho C.C.K.; De La Rosette J.; El-Sakka A.I.; Preto M.; Zenoaga-Barbǎroşie C.; Abumelha S.M.; Baser A.; Aydos K.; Ramirez-Dominguez L.; Kumar V.; Ong T.A.; Mierzwa T.C.; Adriansjah R.; Banihani S.A.; Bowa K.; Fukuhara S.; Peña M.R.R.; Moussa M.; Çaǧin Ari U.; Cho C.-L.; Tadros N.N.; Ugur M.R.; Amar E.; Falcone M.; Santer F.R.; Kalkanli A.; Karna K.K.; Khalafalla K.; Vishwakarma R.B.; Finocchi F.; Giulioni C.; Ceyhan E.; Çeker G.; Yazbeck C.; Rajmil O.; Yilmaz M.; Altay B.; Barrett T.L.; Ngoo K.S.; Roychoudhury S.; Salvio G.; Lin H.; Kadioglu A.; Timpano M.; Avidor-Reiss T.; Hakim L.; Sindhwani P.; Franco G.; Singh R.; Giacone F.; Ruzaev M.; Kosgi R.; Sofikitis N.; Palani A.; Calik G.; Kulaksiz D.; Jezek D.; Hashmi M.A.; Drakopoulos P.; Omran H.; Leonardi S.; Celik-Ozenci C.; Güngör N.D.; Ramsay J.; Amano T.; Sogutdelen E.; Duarsa G.W.K.; Chiba K.; Jindal S.; Savira M.; Boeri L.; Borges E.; Gupte D.; Gokalp F.; Hebrard G.H.; Minhas S.; Shah R.
spellingShingle Farkouh A.; Agarwal A.; Abdel-Meguid Hamoda T.A.A.; Kavoussi P.; Saleh R.; Zini A.; Arafa M.; Harraz A.M.; Gul M.; Karthikeyan V.S.; Durairajanayagam D.; Rambhatla A.; Boitrelle F.; Chung E.; Birowo P.; Toprak T.; Ghayda R.A.; Cannarella R.; Phuoc N.H.V.; Dimitriadis F.; Russo G.I.; Sokolakis I.; Mostafa T.; Makarounis K.; Ziouziou I.; Kuroda S.; Bendayan M.; Kaiyal R.S.; Japari A.; Simopoulou M.; Rocco L.; Garrido N.; Gherabi N.; Bocu K.; Kahraman O.; Le T.V.; Wyns C.; Tremellen K.; Sarikaya S.; Lewis S.; Evenson D.P.; Ko E.; Calogero A.E.; Bahar F.; Martinez M.; Crafa A.; Nguyen Q.; Ambar R.F.; Colpi G.; Bakircioglu M.E.; Henkel R.; Kandil H.; Serefoglu E.C.; Alarbid A.; Tsujimura A.; Kheradmand A.; Anagnostopoulou C.; Marino A.; Adamyan A.; Zilaitiene B.; Ozer C.; Pescatori E.; Vogiatzi P.; Busetto G.M.; Balercia G.; Elbardisi H.; Akhavizadegan H.; Sajadi H.; Taniguchi H.; Park H.J.; Rosas I.M.; Al-Marhoon M.; Gilani M.A.S.; Alhathal N.; Pinggera G.-M.; Kothari P.; Mogharabian N.; Micic S.; Homa S.; Darbandi S.; Long T.Q.T.; Zohdy W.; Atmoko W.; Sabbaghian M.; Ibrahim W.; Smith R.P.; Ho C.C.K.; De La Rosette J.; El-Sakka A.I.; Preto M.; Zenoaga-Barbǎroşie C.; Abumelha S.M.; Baser A.; Aydos K.; Ramirez-Dominguez L.; Kumar V.; Ong T.A.; Mierzwa T.C.; Adriansjah R.; Banihani S.A.; Bowa K.; Fukuhara S.; Peña M.R.R.; Moussa M.; Çaǧin Ari U.; Cho C.-L.; Tadros N.N.; Ugur M.R.; Amar E.; Falcone M.; Santer F.R.; Kalkanli A.; Karna K.K.; Khalafalla K.; Vishwakarma R.B.; Finocchi F.; Giulioni C.; Ceyhan E.; Çeker G.; Yazbeck C.; Rajmil O.; Yilmaz M.; Altay B.; Barrett T.L.; Ngoo K.S.; Roychoudhury S.; Salvio G.; Lin H.; Kadioglu A.; Timpano M.; Avidor-Reiss T.; Hakim L.; Sindhwani P.; Franco G.; Singh R.; Giacone F.; Ruzaev M.; Kosgi R.; Sofikitis N.; Palani A.; Calik G.; Kulaksiz D.; Jezek D.; Hashmi M.A.; Drakopoulos P.; Omran H.; Leonardi S.; Celik-Ozenci C.; Güngör N.D.; Ramsay J.; Amano T.; Sogutdelen E.; Duarsa G.W.K.; Chiba K.; Jindal S.; Savira M.; Boeri L.; Borges E.; Gupte D.; Gokalp F.; Hebrard G.H.; Minhas S.; Shah R.
Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
author_facet Farkouh A.; Agarwal A.; Abdel-Meguid Hamoda T.A.A.; Kavoussi P.; Saleh R.; Zini A.; Arafa M.; Harraz A.M.; Gul M.; Karthikeyan V.S.; Durairajanayagam D.; Rambhatla A.; Boitrelle F.; Chung E.; Birowo P.; Toprak T.; Ghayda R.A.; Cannarella R.; Phuoc N.H.V.; Dimitriadis F.; Russo G.I.; Sokolakis I.; Mostafa T.; Makarounis K.; Ziouziou I.; Kuroda S.; Bendayan M.; Kaiyal R.S.; Japari A.; Simopoulou M.; Rocco L.; Garrido N.; Gherabi N.; Bocu K.; Kahraman O.; Le T.V.; Wyns C.; Tremellen K.; Sarikaya S.; Lewis S.; Evenson D.P.; Ko E.; Calogero A.E.; Bahar F.; Martinez M.; Crafa A.; Nguyen Q.; Ambar R.F.; Colpi G.; Bakircioglu M.E.; Henkel R.; Kandil H.; Serefoglu E.C.; Alarbid A.; Tsujimura A.; Kheradmand A.; Anagnostopoulou C.; Marino A.; Adamyan A.; Zilaitiene B.; Ozer C.; Pescatori E.; Vogiatzi P.; Busetto G.M.; Balercia G.; Elbardisi H.; Akhavizadegan H.; Sajadi H.; Taniguchi H.; Park H.J.; Rosas I.M.; Al-Marhoon M.; Gilani M.A.S.; Alhathal N.; Pinggera G.-M.; Kothari P.; Mogharabian N.; Micic S.; Homa S.; Darbandi S.; Long T.Q.T.; Zohdy W.; Atmoko W.; Sabbaghian M.; Ibrahim W.; Smith R.P.; Ho C.C.K.; De La Rosette J.; El-Sakka A.I.; Preto M.; Zenoaga-Barbǎroşie C.; Abumelha S.M.; Baser A.; Aydos K.; Ramirez-Dominguez L.; Kumar V.; Ong T.A.; Mierzwa T.C.; Adriansjah R.; Banihani S.A.; Bowa K.; Fukuhara S.; Peña M.R.R.; Moussa M.; Çaǧin Ari U.; Cho C.-L.; Tadros N.N.; Ugur M.R.; Amar E.; Falcone M.; Santer F.R.; Kalkanli A.; Karna K.K.; Khalafalla K.; Vishwakarma R.B.; Finocchi F.; Giulioni C.; Ceyhan E.; Çeker G.; Yazbeck C.; Rajmil O.; Yilmaz M.; Altay B.; Barrett T.L.; Ngoo K.S.; Roychoudhury S.; Salvio G.; Lin H.; Kadioglu A.; Timpano M.; Avidor-Reiss T.; Hakim L.; Sindhwani P.; Franco G.; Singh R.; Giacone F.; Ruzaev M.; Kosgi R.; Sofikitis N.; Palani A.; Calik G.; Kulaksiz D.; Jezek D.; Hashmi M.A.; Drakopoulos P.; Omran H.; Leonardi S.; Celik-Ozenci C.; Güngör N.D.; Ramsay J.; Amano T.; Sogutdelen E.; Duarsa G.W.K.; Chiba K.; Jindal S.; Savira M.; Boeri L.; Borges E.; Gupte D.; Gokalp F.; Hebrard G.H.; Minhas S.; Shah R.
author_sort Farkouh A.; Agarwal A.; Abdel-Meguid Hamoda T.A.A.; Kavoussi P.; Saleh R.; Zini A.; Arafa M.; Harraz A.M.; Gul M.; Karthikeyan V.S.; Durairajanayagam D.; Rambhatla A.; Boitrelle F.; Chung E.; Birowo P.; Toprak T.; Ghayda R.A.; Cannarella R.; Phuoc N.H.V.; Dimitriadis F.; Russo G.I.; Sokolakis I.; Mostafa T.; Makarounis K.; Ziouziou I.; Kuroda S.; Bendayan M.; Kaiyal R.S.; Japari A.; Simopoulou M.; Rocco L.; Garrido N.; Gherabi N.; Bocu K.; Kahraman O.; Le T.V.; Wyns C.; Tremellen K.; Sarikaya S.; Lewis S.; Evenson D.P.; Ko E.; Calogero A.E.; Bahar F.; Martinez M.; Crafa A.; Nguyen Q.; Ambar R.F.; Colpi G.; Bakircioglu M.E.; Henkel R.; Kandil H.; Serefoglu E.C.; Alarbid A.; Tsujimura A.; Kheradmand A.; Anagnostopoulou C.; Marino A.; Adamyan A.; Zilaitiene B.; Ozer C.; Pescatori E.; Vogiatzi P.; Busetto G.M.; Balercia G.; Elbardisi H.; Akhavizadegan H.; Sajadi H.; Taniguchi H.; Park H.J.; Rosas I.M.; Al-Marhoon M.; Gilani M.A.S.; Alhathal N.; Pinggera G.-M.; Kothari P.; Mogharabian N.; Micic S.; Homa S.; Darbandi S.; Long T.Q.T.; Zohdy W.; Atmoko W.; Sabbaghian M.; Ibrahim W.; Smith R.P.; Ho C.C.K.; De La Rosette J.; El-Sakka A.I.; Preto M.; Zenoaga-Barbǎroşie C.; Abumelha S.M.; Baser A.; Aydos K.; Ramirez-Dominguez L.; Kumar V.; Ong T.A.; Mierzwa T.C.; Adriansjah R.; Banihani S.A.; Bowa K.; Fukuhara S.; Peña M.R.R.; Moussa M.; Çaǧin Ari U.; Cho C.-L.; Tadros N.N.; Ugur M.R.; Amar E.; Falcone M.; Santer F.R.; Kalkanli A.; Karna K.K.; Khalafalla K.; Vishwakarma R.B.; Finocchi F.; Giulioni C.; Ceyhan E.; Çeker G.; Yazbeck C.; Rajmil O.; Yilmaz M.; Altay B.; Barrett T.L.; Ngoo K.S.; Roychoudhury S.; Salvio G.; Lin H.; Kadioglu A.; Timpano M.; Avidor-Reiss T.; Hakim L.; Sindhwani P.; Franco G.; Singh R.; Giacone F.; Ruzaev M.; Kosgi R.; Sofikitis N.; Palani A.; Calik G.; Kulaksiz D.; Jezek D.; Hashmi M.A.; Drakopoulos P.; Omran H.; Leonardi S.; Celik-Ozenci C.; Güngör N.D.; Ramsay J.; Amano T.; Sogutdelen E.; Duarsa G.W.K.; Chiba K.; Jindal S.; Savira M.; Boeri L.; Borges E.; Gupte D.; Gokalp F.; Hebrard G.H.; Minhas S.; Shah R.
title Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
title_short Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
title_full Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
title_fullStr Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
title_full_unstemmed Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
title_sort Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
publishDate 2023
container_title World Journal of Men's Health
container_volume 41
container_issue 4
doi_str_mv 10.5534/wjmh.230008
url https://www.scopus.com/inward/record.uri?eid=2-s2.0-85163745039&doi=10.5534%2fwjmh.230008&partnerID=40&md5=3a54566996edea258627e4326f5846eb
description Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians. © The Author(s), 2023.
publisher Korean Society for Sexual Medicine and Andrology
issn 22874208
language English
format Article
accesstype All Open Access; Gold Open Access
record_format scopus
collection Scopus
_version_ 1814778503445348352

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    by: Agarwal A.; Farkouh A.; Saleh R.; Hamoda T.A.-A.A.-M.; Harraz A.M.; Kavoussi P.; Arafa M.; Salvio G.; Rambhatla A.; Toprak T.; Gül M.; Phuoc N.H.V.; Boitrelle F.; Birowo P.; Ghayda R.A.; Cannarella R.; Kuroda S.; Durairajanayagam D.; Zini A.; Wyns C.; Sarikaya S.; Tremellen K.; Mostafa T.; Sokolakis I.; Evenson D.P.; Henkel R.; Zohdy W.; Chung E.; Ziouziou I.; Falcone M.; Russo G.I.; Al-Hashimi M.; Calogero A.E.; Ko E.; Colpi G.; Lewis S.; Serefoglu E.C.; Bahar F.; Martinez M.; Nguyen Q.; Ambar R.F.; Bakircioglu M.E.; Kandil H.; Mogharabian N.; Sabbaghian M.; Taniguchi H.; Tsujimura A.; Sajadi H.; Ibrahim W.; Atmoko W.; Vogiatzi P.; Gunes S.; Gilani M.A.S.; Roychoudhury S.; Güngör N.D.; Hakim L.; Adriansjah R.; Kothari P.; Jindal S.; Amar E.; Park H.J.; Long T.Q.T.; Homa S.; Karthikeyan V.S.; Zilaitiene B.; Rosas I.M.; Marino A.; Pescatori E.; Ozer C.; Akhavizadegan H.; Garrido N.; Busetto G.M.; Adamyan A.; Al-Marhoon M.; Elbardisi H.; Dolati P.; Darbandi M.; Darbandi S.; Balercia G.; Pinggera G.-M.; Micic S.; Ho C.C.K.; Moussa M.; Preto M.; Zenoaga-Barbăroșie C.; Smith R.P.; Kosgi R.; de la Rosette J.; El-Sakka A.I.; Abumelha S.M.; Mierzwa T.C.; Ong T.A.; Banihani S.A.; Bowa K.; Fukuhara S.; Boeri L.; Danacıoğlu Y.O.; Gokalp F.; Selim O.M.; Cho C.-L.; Tadros N.N.; Ugur M.R.; Ozkent M.S.; Chiu P.; Kalkanli A.; Khalafalla K.; Vishwakarma R.B.; Finocchi F.; Andreadakis S.; Giulioni C.; Çeker G.; Ceyhan E.; Malhotra V.; Yilmaz M.; Timpano M.; Barrett T.L.; Kim S.H.K.; Ahn S.-T.; Giacone F.; Palani A.; Duarsa G.W.K.; Kadioglu A.; Gadda F.; Zylbersztejn D.S.; Aydos K.; Kulaksız D.; Gupte D.; Calik G.; Karna K.K.; Drakopoulos P.; Baser A.; Kumar V.; Molina J.M.C.; Rajmil O.; Ferreira R.H.; Leonardi S.; Avoyan A.; Sogutdelen E.; Franco G.; Ramsay J.; Ramirez L.; Shah R.; Gherabi N.; Kahraman O.; Trotta C.; Rocco L.; Ngoo K.S.; Sallam H.; El Meliegy A.; Alhathal N.; Chien K.; Lee J.; Le T.V.
    Published: (2023)
  • Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
    by: Agarwal A.; Farkouh A.; Saleh R.; Hamoda T.A.-A.A.-M.; Salvio G.; Boitrelle F.; Harraz A.M.; Ghayda R.A.; Kavoussi P.; Gül M.; Toprak T.; Russo G.I.; Durairajanayagam D.; Rambhatla A.; Birowo P.; Cannarella R.; Phuoc N.H.V.; Zini A.; Arafa M.; Wyns C.; Tremellen K.; Sarıkaya S.; Lewis S.; Evenson D.P.; Ko E.; Calogero A.E.; Bahar F.; Martínez M.; Ambar R.F.; Colpi G.M.; Bakircioglu M.E.; Henkel R.; Kandil H.; Serefoglu E.C.; Alfakhri A.; Tsujimura A.; Kheradmand A.; Marino A.; Adamyan A.; Zilaitiene B.; Ozer C.; Pescatori E.; Vogiatzi P.; Busetto G.M.; Balercia G.; Elbardisi H.; Akhavizadegan H.; Sajadi H.; Taniguchi H.; Park H.J.; Rosas I.M.; Al-Marhoon M.; Gilani M.A.S.; Alhathal N.; Quang N.; Pinggera G.-M.; Kothari P.; Micic S.; Homa S.; Long T.Q.T.; Zohdy W.; Atmoko W.; Ibrahim W.; Sabbaghian M.; Abumelha S.M.; Chung E.; Ugur M.R.; Ozkent M.S.; Selim O.; Darbandi M.; Fukuhara S.; Jamali M.; de la Rosette J.; Kuroda S.; Smith R.P.; Baser A.; Kalkanli A.; Tadros N.N.; Aydos K.; Mierzwa T.C.; Khalafalla K.; Malhotra V.; Moussa M.; Finocchi F.; Rachman R.I.; Giulioni C.; Avidor-Reiss T.; Kahraman O.; Çeker G.; Zenoaga-Barbăroșie C.; Barrett T.L.; Yilmaz M.; Kadioglu A.; Jindal S.; Omran H.; Bocu K.; Karthikeyan V.S.; Franco G.; Solorzano J.F.; Vishwakarma R.B.; Arianto E.; Garrido N.; Jain D.; Gherabi N.; Sokolakis I.; Palani A.; Calik G.; Kulaksiz D.; Simanaviciene V.; Simopoulou M.; Güngör N.D.; Blecher G.; Falcone M.; Jezek D.; Preto M.; Amar E.; Le T.V.; Ahn S.T.; Rezano A.; Singh K.; Rocco L.; Savira M.; Rajmil O.; Darbandi S.; Sogutdelen E.; Boeri L.; Hernández G.; Hakim L.; Morimoto Y.; Japari A.; Sofikitis N.; Altay B.; Mahmutoglu A.M.; Al Hashimi M.; Ziouziou I.; Anagnostopoulou C.; Lin H.; Shah R.
    Published: (2023)
  • Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis
    by: Agarwal A.; Cannarella R.; Saleh R.; Boitrelle F.; Gül M.; Toprak T.; Salvio G.; Arafa M.; Russo G.I.; Harraz A.M.; Singh R.; Garrido N.; Abdel-Meguid Hamoda T.A.-A.; Rambhatla A.; Kavoussi P.; Kuroda S.; Çalik G.; Saini P.; Ceyhan E.; Dimitriadis F.; Henkel R.; Crafa A.; Palani A.; Duran M.B.; Maziotis E.; Saïs É.; Bendayan M.; Darbandi M.; Le T.V.; Gunes S.; Tsioulou P.; Sengupta P.; Hazir B.; Çeker G.; Darbandi S.; Durairajanayagam D.; Aghamajidi A.; Alkhalidi N.; Sogutdelen E.; Leisegang K.; Alarbid A.; Ho C.C.K.; Malhotra V.; Finocchi F.; Crisóstomo L.; Kosgi R.; ElBardisi H.; Zini A.; Birowo P.; Colpi G.; Park H.J.; Serefoglu E.C.; Nguyen Q.; Ko E.; de la Rosette J.; Pinggera G.M.; Nguyen H.V.P.; Kandil H.; Shah R.
    Published: (2022)
  • Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial
    by: Connolly S.J.; Eikelboom J.W.; Bosch J.; Dagenais G.; Dyal L.; Lanas F.; Metsarinne K.; O'Donnell M.; Dans A.L.; Ha J.-W.; Parkhomenko A.N.; Avezum A.A.; Lonn E.; Lisheng L.; Torp-Pedersen C.; Widimsky P.; Maggioni A.P.; Felix C.; Keltai K.; Hori M.; Yusoff K.; Guzik T.J.; Bhatt D.L.; Branch K.R.H.; Cook Bruns N.; Berkowitz S.D.; Anand S.S.; Varigos J.D.; Fox K.A.A.; Yusuf S.; SALA J.; CARTASEGNA L.U.I.S.; VICO M.; HOMINAL M.A.; HASBANI E.; CACCAVO A.; ZAIDMAN C.; VOGEL D.; HRABAR A.; SCHYGIEL P.O.; CUNEO C.; LUQUEZ H.U.G.O.; MACKINNON I.J.; AHUAD GUERRERO R.A.; COSTABEL J.P.; BARTOLACCI I.P.; MONTANA O.; BARBIERI M.; GOMEZ VILAMAJO O.; GARCIA DURAN R.O.; SCHIAVI L.B.; GARRIDO M.; INGARAMO A.; BORDONAVA A.P.; PELAGAGGE M.J.; NOVARETTO L.; ALBISU DI GENNERO J.P.; IBANEZ SAGGIA L.M.; ALVAREZ M.; VITA N.A.; MACIN S.M.; DRAN R.D.; CARDONA M.; GUZMAN L.U.I.S.; SARJANOVICH R.J.; CUADRADO J.; NANI S.; LITVAK BRUNO M.R.; CHACON C.; MAFFEI L.E.; GRINFELD D.; VENSENTINI N.; MAJUL C.R.; LUCIARDI H.L.; GONZALEZ COLASO P.D.C.; FERRE PACORA F.A.; VAN DEN HEUVEL P.A.U.L.; VERHAMME P.; ECTOR B.A.V.O.; DEBONNAIRE P.; VAN DE BORNE P.; LEROY J.E.A.N.; SCHROE H.; VRANCKX P.; ELEGEERT I.V.A.N.; HOFFER E.; DUJARDIN K.A.R.L.; INDIO DO BRASIL C.; PRECOMA D.; ABRANTES J.A.; MANENTI E.; REIS G.; SARAIVA J.O.S.E.; MAIA L.; HERNANDES M.; ROSSI P.; ROSSI DOS SANTOS F.; ZIMMERMANN S.L.; RECH R.; ABIB E., et al.
    Published: (2018)