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

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

Agarwal A^{1, 2} ; Farkouh A¹ ; Saleh R^{1, 3} ; Hamoda TAAAM^{1, 4, 5} ; Salvio G^{1, 6} ; Boitrelle F^{1, 7, 8} ; Harraz AM^{1, 9, 10, 11} ; Ghayda RA^{1, 12} ; Kavoussi P^{1, 13} ; Gul M^{1, 14} ; Toprak T^{1, 15} ; Russo GI^{1, 16} ; Durairajanayagam D^{1, 17} ; Rambhatla A^{1, 18} Show All Authors

Agarwal A^{1, 2}
Farkouh A¹
Saleh R^{1, 3}
Hamoda TAAAM^{1, 4, 5}
Salvio G^{1, 6}
Boitrelle F^{1, 7, 8}
Harraz AM^{1, 9, 10, 11}
Ghayda RA^{1, 12}
Kavoussi P^{1, 13}
Gul M^{1, 14}
Toprak T^{1, 15}
Russo GI^{1, 16}
Durairajanayagam D^{1, 17}
Rambhatla A^{1, 18}
Birowo P^{1, 19}
Cannarella R^{1, 20, 21}
Phuoc NHV^{1, 22, 23}
Zini A^{1, 24}
Arafa M^{1, 25, 26, 27}
Wyns C^{1, 28}
Tremellen K^{1, 29}
Sarikaya S^{1, 30}
Lewis S^{1, 31}
Evenson DP^{1, 32}
Ko E^{1, 33}
Calogero AE^{1, 10}
Bahar F^{1, 34}
Martinez M^{1, 35}
Ambar RF^{1, 36, 37}
Colpi GM^{1, 38}
Bakircioglu ME^{1, 39}
Henkel R^{1, 40, 41}
Kandil H^{1, 42}
Serefoglu EC^{1, 43}
Alfakhri A^{1, 44}
Tsujimura A^{1, 45}
Kheradmand A^{1, 46}
Marino A^{1, 47}
Adamyan A^{1, 48}
Zilaitiene B^{1, 49}
Ozer C^{1, 50}
Pescatori E^{1, 51}
Vogiatzi P^{1, 52}
Busetto GM^{1, 53}
Balercia G^{1, 6}
Elbardisi H^{1, 25, 26, 54}
Akhavizadegan H^{1, 55}
Sajadi H^{1, 56}
Taniguchi H^{1, 57}
Park HJ^{1, 58, 59}
Rosas IM^{1, 60}
Almarhoon M^{1, 61}
Gilani MAS^{1, 56}
Alhathal N^{1, 62}
Quang N^{1, 63, 64}
Pinggera GM^{1, 65}
Kothari P^{1, 66}
Micic S^{1, 67}
Homa S^{1, 68}
Long TQT^{1, 69}
Zohdy W^{1, 27}
Atmoko W^{1, 19}
Ibrahim W^{1, 70}
Sabbaghian M^{1, 56}
Abumelha SM^{1, 71}
Chung E^{1, 72}
Ugur MR^{1, 73}
Ozkent MS^{1, 74}
Selim O^{1, 27}
Darbandi M^{1, 75, 76}
Fukuhara S^{1, 77}
Jamali M^{1, 78}
De La Rosette J^{1, 79}
Kuroda S²¹
Smith RP^{1, 80}
Baser A^{1, 81}
Kalkanli A^{1, 82}
Tadros NN^{1, 83}
Aydos K^{1, 84}
Mierzwa TC^{1, 85}
Khalafalla K^{1, 25, 86, 87}
Malhotra V^{1, 88}
Moussa M^{1, 89, 90}
Finocchi F^{1, 6}
Rachman RI^{1, 19}
Giulioni C^{1, 6}
Avidorreiss T^{1, 91, 92}
Kahraman O^{1, 51}
Ceker G⁹³
Zenoagabarbarosie C^{1, 94}
Barrett TL^{1, 95}
Yilmaz M^{1, 96}
Kadioglu A^{1, 97}
Jindal S^{1, 98}
Omran H^{1, 99}
Bocu K^{1, 100}
Karthikeyan VS^{1, 101}
Franco G^{1, 102}
Solorzano JF^{1, 60}
Vishwakarma RB^{1, 103}
Arianto E^{1, 104}
Garrido N^{1, 105}
Jain D^{1, 106}
Gherabi N^{1, 107}
Sokolakis I^{1, 108}
Palani A^{1, 109}
Calik G^{1, 79}
Kulaksiz D^{1, 110}
Simanaviciene V^{1, 111}
Simopoulou M^{1, 112}
Gungor ND^{1, 113}
Blecher G^{1, 114}
Falcone M^{1, 115}
Jezek D^{1, 116}
Preto M^{1, 115}
Amar E^{1, 117}
Le TV^{1, 22, 23}
Ahn ST^{1, 118}
Rezano A^{1, 119}
Singh K^{1, 120}
Rocco L^{1, 121}
Savira M^{1, 19}
Rajmil O^{1, 122}
Darbandi S^{1, 75, 76}
Sogutdelen E^{1, 123}
Boeri L^{1, 124}
Hernandez G^{1, 125}
Hakim L^{1, 126}
Morimoto Y^{1, 127}
Japari A^{1, 128}
Sofikitis N^{1, 129}
Altay B^{1, 130}
Mahmutoglu AM^{1, 131}
Al Hashimi M^{1, 132}
Ziouziou I^{1, 133}
Anagnostopoulou C^{1, 134}
Lin H^{1, 135}
Shah R^{1, 103}

Source: World Journal of Men's Health Published:2023

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. Copyright © 2023 Korean Society for Sexual Medicine and Andrology.

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Mohammad Ali Sadighi Gilani (6)

Hamed Akhavizadegan (4)

Style	Citing Format
MLA	Agarwal A, et al.. "Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations." World Journal of Men's Health, vol. 41, no. , 2023, pp. -.
APA	Agarwal A, Farkouh A, Saleh R, Hamoda TAAAM, Salvio G, Boitrelle F, Harraz AM, Ghayda RA, Kavoussi P, Gul M, Toprak T, Russo GI, Durairajanayagam D, Rambhatla A, Birowo P, Cannarella R, Phuoc NHV, Zini A, Arafa M, ... Shah R (2023). Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World Journal of Men's Health, 41(), -.
Chicago	Agarwal A, Farkouh A, Saleh R, Hamoda TAAAM, Salvio G, Boitrelle F, Harraz AM, et al.. "Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations." World Journal of Men's Health 41, no. (2023): -.
Harvard	Agarwal A et al. (2023) 'Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations', World Journal of Men's Health, 41(), pp. -.
Vancouver	Agarwal A, Farkouh A, Saleh R, Hamoda TAAAM, Salvio G, Boitrelle F, et al.. Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World Journal of Men's Health. 2023;41():-.
BibTex	@article{ author = {Agarwal A and Farkouh A and Saleh R and Hamoda TAAAM and Salvio G and Boitrelle F and Harraz AM and Ghayda RA and Kavoussi P and Gul M and Toprak T and Russo GI and Durairajanayagam D and Rambhatla A and Birowo P and Cannarella R and Phuoc NHV and Zini A and Arafa M and Wyns C and Tremellen K and Sarikaya S and Lewis S and Evenson DP and Ko E and Calogero AE and Bahar F and Martinez M and Ambar RF and Colpi GM and Bakircioglu ME and Henkel R and Kandil H and Serefoglu EC and Alfakhri A and Tsujimura A and Kheradmand A and Marino A and Adamyan A and Zilaitiene B and Ozer C and Pescatori E and Vogiatzi P and Busetto GM and Balercia G and Elbardisi H and Akhavizadegan H and Sajadi H and Taniguchi H and Park HJ and Rosas IM and Almarhoon M and Gilani MAS and Alhathal N and Quang N and Pinggera GM and Kothari P and Micic S and Homa S and Long TQT and Zohdy W and Atmoko W and Ibrahim W and Sabbaghian M and Abumelha SM and Chung E and Ugur MR and Ozkent MS and Selim O and Darbandi M and Fukuhara S and Jamali M and De La Rosette J and Kuroda S and Smith RP and Baser A and Kalkanli A and Tadros NN and Aydos K and Mierzwa TC and Khalafalla K and Malhotra V and Moussa M and Finocchi F and Rachman RI and Giulioni C and Avidorreiss T and Kahraman O and Ceker G and Zenoagabarbarosie C and Barrett TL and Yilmaz M and Kadioglu A and Jindal S and Omran H and Bocu K and Karthikeyan VS and Franco G and Solorzano JF and Vishwakarma RB and Arianto E and Garrido N and Jain D and Gherabi N and Sokolakis I and Palani A and Calik G and Kulaksiz D and Simanaviciene V and Simopoulou M and Gungor ND and Blecher G and Falcone M and Jezek D and Preto M and Amar E and Le TV and Ahn ST and Rezano A and Singh K and Rocco L and Savira M and Rajmil O and Darbandi S and Sogutdelen E and Boeri L and Hernandez G and Hakim L and Morimoto Y and Japari A and Sofikitis N and Altay B and Mahmutoglu AM and Al Hashimi M and Ziouziou I and Anagnostopoulou C and Lin H and Shah R}, title = {Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations}, journal = {World Journal of Men's Health}, volume = {41}, number = {}, pages = {-}, year = {2023} }
RIS	TY - JOUR AU - Agarwal A AU - Farkouh A AU - Saleh R AU - Hamoda TAAAM AU - Salvio G AU - Boitrelle F AU - Harraz AM AU - Ghayda RA AU - Kavoussi P AU - Gul M AU - Toprak T AU - Russo GI AU - Durairajanayagam D AU - Rambhatla A AU - Birowo P AU - Cannarella R AU - Phuoc NHV AU - Zini A AU - Arafa M AU - Wyns C AU - Tremellen K AU - Sarikaya S AU - Lewis S AU - Evenson DP AU - Ko E AU - Calogero AE AU - Bahar F AU - Martinez M AU - Ambar RF AU - Colpi GM AU - Bakircioglu ME AU - Henkel R AU - Kandil H AU - Serefoglu EC AU - Alfakhri A AU - Tsujimura A AU - Kheradmand A AU - Marino A AU - Adamyan A AU - Zilaitiene B AU - Ozer C AU - Pescatori E AU - Vogiatzi P AU - Busetto GM AU - Balercia G AU - Elbardisi H AU - Akhavizadegan H AU - Sajadi H AU - Taniguchi H AU - Park HJ AU - Rosas IM AU - Almarhoon M AU - Gilani MAS AU - Alhathal N AU - Quang N AU - Pinggera GM AU - Kothari P AU - Micic S AU - Homa S AU - Long TQT AU - Zohdy W AU - Atmoko W AU - Ibrahim W AU - Sabbaghian M AU - Abumelha SM AU - Chung E AU - Ugur MR AU - Ozkent MS AU - Selim O AU - Darbandi M AU - Fukuhara S AU - Jamali M AU - De La Rosette J AU - Kuroda S AU - Smith RP AU - Baser A AU - Kalkanli A AU - Tadros NN AU - Aydos K AU - Mierzwa TC AU - Khalafalla K AU - Malhotra V AU - Moussa M AU - Finocchi F AU - Rachman RI AU - Giulioni C AU - Avidorreiss T AU - Kahraman O AU - Ceker G AU - Zenoagabarbarosie C AU - Barrett TL AU - Yilmaz M AU - Kadioglu A AU - Jindal S AU - Omran H AU - Bocu K AU - Karthikeyan VS AU - Franco G AU - Solorzano JF AU - Vishwakarma RB AU - Arianto E AU - Garrido N AU - Jain D AU - Gherabi N AU - Sokolakis I AU - Palani A AU - Calik G AU - Kulaksiz D AU - Simanaviciene V AU - Simopoulou M AU - Gungor ND AU - Blecher G AU - Falcone M AU - Jezek D AU - Preto M AU - Amar E AU - Le TV AU - Ahn ST AU - Rezano A AU - Singh K AU - Rocco L AU - Savira M AU - Rajmil O AU - Darbandi S AU - Sogutdelen E AU - Boeri L AU - Hernandez G AU - Hakim L AU - Morimoto Y AU - Japari A AU - Sofikitis N AU - Altay B AU - Mahmutoglu AM AU - Al Hashimi M AU - Ziouziou I AU - Anagnostopoulou C AU - Lin H AU - Shah R TI - Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations JO - World Journal of Men's Health VL - 41 IS - SP - EP - PY - 2023 ER -

Style

Citing Format

MLA

Agarwal A, et al.. "Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations." World Journal of Men's Health, vol. 41, no. , 2023, pp. -.

APA

Agarwal A, Farkouh A, Saleh R, Hamoda TAAAM, Salvio G, Boitrelle F, Harraz AM, Ghayda RA, Kavoussi P, Gul M, Toprak T, Russo GI, Durairajanayagam D, Rambhatla A, Birowo P, Cannarella R, Phuoc NHV, Zini A, Arafa M, ... Shah R (2023). Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World Journal of Men's Health, 41(), -.

Chicago

Agarwal A, Farkouh A, Saleh R, Hamoda TAAAM, Salvio G, Boitrelle F, Harraz AM, et al.. "Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations." World Journal of Men's Health 41, no. (2023): -.

Harvard

Agarwal A et al. (2023) 'Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations', World Journal of Men's Health, 41(), pp. -.

Vancouver

Agarwal A, Farkouh A, Saleh R, Hamoda TAAAM, Salvio G, Boitrelle F, et al.. Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World Journal of Men's Health. 2023;41():-.

BibTex

@article{ author = {Agarwal A and Farkouh A and Saleh R and Hamoda TAAAM and Salvio G and Boitrelle F and Harraz AM and Ghayda RA and Kavoussi P and Gul M and Toprak T and Russo GI and Durairajanayagam D and Rambhatla A and Birowo P and Cannarella R and Phuoc NHV and Zini A and Arafa M and Wyns C and Tremellen K and Sarikaya S and Lewis S and Evenson DP and Ko E and Calogero AE and Bahar F and Martinez M and Ambar RF and Colpi GM and Bakircioglu ME and Henkel R and Kandil H and Serefoglu EC and Alfakhri A and Tsujimura A and Kheradmand A and Marino A and Adamyan A and Zilaitiene B and Ozer C and Pescatori E and Vogiatzi P and Busetto GM and Balercia G and Elbardisi H and Akhavizadegan H and Sajadi H and Taniguchi H and Park HJ and Rosas IM and Almarhoon M and Gilani MAS and Alhathal N and Quang N and Pinggera GM and Kothari P and Micic S and Homa S and Long TQT and Zohdy W and Atmoko W and Ibrahim W and Sabbaghian M and Abumelha SM and Chung E and Ugur MR and Ozkent MS and Selim O and Darbandi M and Fukuhara S and Jamali M and De La Rosette J and Kuroda S and Smith RP and Baser A and Kalkanli A and Tadros NN and Aydos K and Mierzwa TC and Khalafalla K and Malhotra V and Moussa M and Finocchi F and Rachman RI and Giulioni C and Avidorreiss T and Kahraman O and Ceker G and Zenoagabarbarosie C and Barrett TL and Yilmaz M and Kadioglu A and Jindal S and Omran H and Bocu K and Karthikeyan VS and Franco G and Solorzano JF and Vishwakarma RB and Arianto E and Garrido N and Jain D and Gherabi N and Sokolakis I and Palani A and Calik G and Kulaksiz D and Simanaviciene V and Simopoulou M and Gungor ND and Blecher G and Falcone M and Jezek D and Preto M and Amar E and Le TV and Ahn ST and Rezano A and Singh K and Rocco L and Savira M and Rajmil O and Darbandi S and Sogutdelen E and Boeri L and Hernandez G and Hakim L and Morimoto Y and Japari A and Sofikitis N and Altay B and Mahmutoglu AM and Al Hashimi M and Ziouziou I and Anagnostopoulou C and Lin H and Shah R}, title = {Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations}, journal = {World Journal of Men's Health}, volume = {41}, number = {}, pages = {-}, year = {2023} }

RIS

TY - JOUR
AU - Agarwal A
AU - Farkouh A
AU - Saleh R
AU - Hamoda TAAAM
AU - Salvio G
AU - Boitrelle F
AU - Harraz AM
AU - Ghayda RA
AU - Kavoussi P
AU - Gul M
AU - Toprak T
AU - Russo GI
AU - Durairajanayagam D
AU - Rambhatla A
AU - Birowo P
AU - Cannarella R
AU - Phuoc NHV
AU - Zini A
AU - Arafa M
AU - Wyns C
AU - Tremellen K
AU - Sarikaya S
AU - Lewis S
AU - Evenson DP
AU - Ko E
AU - Calogero AE
AU - Bahar F
AU - Martinez M
AU - Ambar RF
AU - Colpi GM
AU - Bakircioglu ME
AU - Henkel R
AU - Kandil H
AU - Serefoglu EC
AU - Alfakhri A
AU - Tsujimura A
AU - Kheradmand A
AU - Marino A
AU - Adamyan A
AU - Zilaitiene B
AU - Ozer C
AU - Pescatori E
AU - Vogiatzi P
AU - Busetto GM
AU - Balercia G
AU - Elbardisi H
AU - Akhavizadegan H
AU - Sajadi H
AU - Taniguchi H
AU - Park HJ
AU - Rosas IM
AU - Almarhoon M
AU - Gilani MAS
AU - Alhathal N
AU - Quang N
AU - Pinggera GM
AU - Kothari P
AU - Micic S
AU - Homa S
AU - Long TQT
AU - Zohdy W
AU - Atmoko W
AU - Ibrahim W
AU - Sabbaghian M
AU - Abumelha SM
AU - Chung E
AU - Ugur MR
AU - Ozkent MS
AU - Selim O
AU - Darbandi M
AU - Fukuhara S
AU - Jamali M
AU - De La Rosette J
AU - Kuroda S
AU - Smith RP
AU - Baser A
AU - Kalkanli A
AU - Tadros NN
AU - Aydos K
AU - Mierzwa TC
AU - Khalafalla K
AU - Malhotra V
AU - Moussa M
AU - Finocchi F
AU - Rachman RI
AU - Giulioni C
AU - Avidorreiss T
AU - Kahraman O
AU - Ceker G
AU - Zenoagabarbarosie C
AU - Barrett TL
AU - Yilmaz M
AU - Kadioglu A
AU - Jindal S
AU - Omran H
AU - Bocu K
AU - Karthikeyan VS
AU - Franco G
AU - Solorzano JF
AU - Vishwakarma RB
AU - Arianto E
AU - Garrido N
AU - Jain D
AU - Gherabi N
AU - Sokolakis I
AU - Palani A
AU - Calik G
AU - Kulaksiz D
AU - Simanaviciene V
AU - Simopoulou M
AU - Gungor ND
AU - Blecher G
AU - Falcone M
AU - Jezek D
AU - Preto M
AU - Amar E
AU - Le TV
AU - Ahn ST
AU - Rezano A
AU - Singh K
AU - Rocco L
AU - Savira M
AU - Rajmil O
AU - Darbandi S
AU - Sogutdelen E
AU - Boeri L
AU - Hernandez G
AU - Hakim L
AU - Morimoto Y
AU - Japari A
AU - Sofikitis N
AU - Altay B
AU - Mahmutoglu AM
AU - Al Hashimi M
AU - Ziouziou I
AU - Anagnostopoulou C
AU - Lin H
AU - Shah R
TI - Technical Aspects and Clinical Limitations of Sperm Dna Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
JO - World Journal of Men's Health
VL - 41
IS -
SP -
EP -
PY - 2023
ER -

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