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Journal Article Ppublish 19 citations

PubMed: 37118965 DOI: 10.5534/wjmh.230008

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

World J Mens Health 41(4):809-847

Authors: Ala'a Farkouh, Ashok Agarwal, Taha Abo-Almagd Abdel-Meguid Hamoda, Parviz Kavoussi, Ramadan Saleh, Armand Zini, Mohamed Arafa, Ahmed M Harraz, Murat Gul, Vilvapathy Senguttuvan Karthikeyan, Damayanthi Durairajanayagam, Amarnath Rambhatla, Florence Boitrelle, Eric Chung, Ponco Birowo, Tuncay Toprak, Ramy Abou Ghayda, Rossella Cannarella, Nguyen Ho Vinh Phuoc, Fotios Dimitriadis, Giorgio I Russo, Ioannis Sokolakis, Taymour Mostafa, Konstantinos Makarounis, Imad Ziouziou, Shinnosuke Kuroda, Marion Bendayan, Raneen Sawaid Kaiyal, Andrian Japari, Mara Simopoulou, Lucia Rocco, Nicolas Garrido, Nazim Gherabi, Kadir Bocu, Oguzhan Kahraman, Tan V Le, Christine Wyns, Kelton Tremellen, Selcuk Sarikaya, Sheena Lewis, Donald P Evenson, Edmund Ko, Aldo E Calogero, Fahmi Bahar, Marlon Martinez, Andrea Crafa, Quang Nguyen, Rafael F Ambar, Giovanni Colpi, Mustafa Emre Bakircioglu … and 113 other authors

Affiliations

  • Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA.
  • Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.
  • Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt.
  • Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.
  • Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
  • Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt.
  • Department of Surgery, McGill University, Montreal, QC, Canada.
  • Department of Urology, Hamad Medical Corporation, Doha, Qatar.
  • Department of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt.
  • Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.
  • Urology Department, Urology and Nephrology Center, Mansoura University, Mansura, Egypt.
  • Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait.
  • Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.
  • Department of Urology, Selçuk University School of Medicine, Konya, Turkey.
  • Andrology Unit, Department of Urology, Apollo Hospitals, Chennai, India.
  • Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
  • Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA.
  • Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.
  • Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France.
  • Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
  • Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
  • Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
  • Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
  • Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
  • Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.
  • Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
  • Department of Urology, Aristotle University, School of Medicine, Thessaloniki, .
  • Urology Section, University of Catania, Catania, Italy.
  • Department of Urology and Andrology, Locus Medicus, Athens, Greece.
  • Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco.
  • Fertility Clinic, Telogorejo Hospital, Semarang, Indonesia.
  • Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.
  • IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
  • Department of Urology, University of Algiers, Algiers, Algeria.
  • Department of Urology, Silopi State Hospital, Sirnak, Turkey.
  • Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey.
  • Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
  • Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, South Australia, Australia.
  • Department of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
  • Examen Lab Ltd. Northern Ireland, UK.
  • SCSA Diagnostics, Brookings, SDUSA, USA.
  • Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
  • Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia.
  • Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines.
  • Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam.
  • Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
  • Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil.
  • Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil.
  • Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland.
  • SENSART Clinic, Urology, Fulya, Istanbul, Turkey.

Abstract

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.

MeSH

Infertility, Antioxidants, Dna Fragmentation, Varicocele, Infertility, Male, Spermatozoa, Dna

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