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Journal Article Ppublish 23 citations

PubMed: 37635341 DOI: 10.5534/wjmh.230076

Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.

World J Mens Health 42(1):202-215

Authors: Ashok Agarwal, Ala'a Farkouh, Ramadan Saleh, Taha Abo-Almagd Abdel-Meguid Hamoda, Gianmaria Salvio, Florence Boitrelle, Ahmed M Harraz, Ramy Abou Ghayda, Parviz Kavoussi, Murat Gül, Tuncay Toprak, Giorgio Ivan Russo, Damayanthi Durairajanayagam, Amarnath Rambhatla, Ponco Birowo, Rossella Cannarella, Nguyen Ho Vinh Phuoc, Armand Zini, Mohamed Arafa, Christine Wyns, Kelton Tremellen, Selçuk Sarıkaya, Sheena Lewis, Donald P Evenson, Edmund Ko, Aldo E Calogero, Fahmi Bahar, Marlon Martínez, Rafael F Ambar, Giovanni M Colpi, Mustafa Emre Bakircioglu, Ralf Henkel, Hussein Kandil, Ege Can Serefoglu, Abdullah Alfakhri, Akira Tsujimura, Alireza Kheradmand, Angelo Marino, Aram Adamyan, Birute Zilaitiene, Cevahir Ozer, Edoardo Pescatori, Paraskevi Vogiatzi, Gian Maria Busetto, Giancarlo Balercia, Haitham Elbardisi, Hamed Akhavizadegan, Hesamoddin Sajadi, Hisanori Taniguchi, Hyun Jun Park … and 88 other authors

Affiliations

  • Global Andrology Forum, Moreland Hills, OH, USA.
  • Cleveland Clinic, Cleveland, OH, USA.
  • Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
  • Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.
  • Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt.
  • Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy.
  • 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.
  • Urology and Nephrology Center, Mansoura, Egypt.
  • Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait.
  • Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.
  • Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
  • Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.
  • Department of Urology, Selçuk University School of Medicine, Konya, Turkey.
  • Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
  • Urology Section, University of Catania, Catania, Italy.
  • 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.
  • Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
  • 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 Surgery, McGill University, Montreal, QC, Canada.
  • Department of Urology, Hamad Medical Corporation, Doha, Qatar.
  • Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.
  • Department of Andrology and STDs, Cairo University, Cairo, Egypt.
  • Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Universitat Catholique de Louvain, Brussels, Belgium.
  • Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia.
  • Department of Urology, Galhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
  • Examen Lab Ltd. Northern Ireland, UK.
  • SCSA Diagnostics, Brookings, SD, 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.
  • Department of Urology, Centro Universitario em Saude do ABC, Santo Andre, Brazil.
  • Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil.
  • Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland.
  • SENSART Clinic, Urology, Fulya, Istanbul, Turkey.
  • Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
  • Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.
  • Fakih IVF Fertility Center, Abu Dhabi, UAE.
  • Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.
  • Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia.
  • Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan.
  • Department of Urology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
  • Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy.
  • IVF Department, Astghik Medical Center, Yerevan, Armenia.
  • Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
  • Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey.
  • Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy.
  • Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece.
  • Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy.
  • Department of Urology, College of Medicine, Qatar University, Doha, Qatar.
  • Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
  • Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan.
  • Department of Urology, Pusan National University School of Medicine, Busan, Korea.
  • Medical Research Institute of Pusan National University Hospital, Busan, Korea.

Abstract

PURPOSE

Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice.

MATERIALS AND METHODS

Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured.

RESULTS

The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%).

CONCLUSIONS

This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial.

MeSH

Research Design, Laboratories, Infertility, Chromatin, Dna Fragmentation, Infertility, Male, Spermatozoa, Dna, Dna Nucleotidylexotransferase

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