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



Farkouh A1 ; Agarwal A1, 2 ; Abdelmeguid Hamoda TAA3, 4 ; Kavoussi P5 ; Saleh R6, 7 ; Zini A8 ; Arafa M9, 10, 11 ; Harraz AM12, 13, 14 ; Gul M15 ; Karthikeyan VS16 ; Durairajanayagam D17 ; Rambhatla A18 ; Boitrelle F19, 20 ; Chung E21 Show All Authors
Authors
  1. Farkouh A1
  2. Agarwal A1, 2
  3. Abdelmeguid Hamoda TAA3, 4
  4. Kavoussi P5
  5. Saleh R6, 7
  6. Zini A8
  7. Arafa M9, 10, 11
  8. Harraz AM12, 13, 14
  9. Gul M15
  10. Karthikeyan VS16
  11. Durairajanayagam D17
  12. Rambhatla A18
  13. Boitrelle F19, 20
  14. Chung E21
  15. Birowo P22
  16. Toprak T23
  17. Ghayda RA24
  18. Cannarella R25, 26
  19. Phuoc NHV27, 28
  20. Dimitriadis F29
  21. Russo GI30
  22. Sokolakis I29
  23. Mostafa T10
  24. Makarounis K31
  25. Ziouziou I32
  26. Kuroda S26
  27. Bendayan M19
  28. Kaiyal RS26
  29. Japari A33
  30. Simopoulou M34
  31. Rocco L35
  32. Garrido N36
  33. Gherabi N37
  34. Bocu K38
  35. Kahraman O39
  36. Le TV27, 28
  37. Wyns C40
  38. Tremellen K41
  39. Sarikaya S42
  40. Lewis S43
  41. Evenson DP44
  42. Ko E45
  43. Calogero AE25
  44. Bahar F46
  45. Martinez M47
  46. Crafa A25
  47. Nguyen Q48, 49
  48. Ambar RF50, 51
  49. Colpi G52
  50. Bakircioglu ME53
  51. Henkel R54, 55
  52. Kandil H56
  53. Serefoglu EC57
  54. Alarbid A13
  55. Tsujimura A58
  56. Kheradmand A59
  57. Anagnostopoulou C60
  58. Marino A61
  59. Adamyan A62
  60. Zilaitiene B63
  61. Ozer C39
  62. Pescatori E64
  63. Vogiatzi P65
  64. Busetto GM66
  65. Balercia G67
  66. Elbardisi H9, 10
  67. Akhavizadegan H68
  68. Sajadi H69
  69. Taniguchi H70
  70. Park HJ71, 72
  71. Rosas IM73
  72. Almarhoon M74
  73. Gilani MAS69
  74. Alhathal N75
  75. Pinggera GM76
  76. Kothari P77
  77. Mogharabian N78
  78. Micic S79
  79. Homa S80
  80. Darbandi S81, 82
  81. Long TQT83
  82. Zohdy W10
  83. Atmoko W22
  84. Sabbaghian M69
  85. Ibrahim W84
  86. Smith RP85
  87. Ho CCK86
  88. De La Rosette J87
  89. Elsakka AI88
  90. Preto M89
  91. Zenoagabarbarosie C90
  92. Abumelha SM91
  93. Baser A92
  94. Aydos K93
  95. Ramirezdominguez L73
  96. Kumar V94
  97. Ong TA95
  98. Mierzwa TC96
  99. Adriansjah R97
  100. Banihani SA98
  101. Bowa K99
  102. Fukuhara S100
  103. Pena MRR101
  104. Moussa M102, 103
  105. Cagin Ari U104
  106. Cho CL105
  107. Tadros NN106
  108. Ugur MR107
  109. Amar E108
  110. Falcone M109
  111. Santer FR76
  112. Kalkanli A110
  113. Karna KK111
  114. Khalafalla K9, 112, 113
  115. Vishwakarma RB114
  116. Finocchi F67
  117. Giulioni C115
  118. Ceyhan E39
  119. Ceker G116
  120. Yazbeck C117
  121. Rajmil O118
  122. Yilmaz M119
  123. Altay B120
  124. Barrett TL121
  125. Ngoo KS122
  126. Roychoudhury S123
  127. Salvio G67
  128. Lin H124
  129. Kadioglu A125
  130. Timpano M109
  131. Avidorreiss T126, 127
  132. Hakim L128
  133. Sindhwani P128
  134. Franco G129
  135. Singh R130
  136. Giacone F131
  137. Ruzaev M132
  138. Kosgi R133
  139. Sofikitis N134
  140. Palani A135
  141. Calik G87
  142. Kulaksiz D136
  143. Jezek D137
  144. Hashmi MA138, 139
  145. Drakopoulos P140, 141
  146. Omran H142
  147. Leonardi S143
  148. Celikozenci C144
  149. Gungor ND145
  150. Ramsay J146
  151. Amano T147
  152. Sogutdelen E148
  153. Duarsa GWK149
  154. Chiba K150
  155. Jindal S151
  156. Savira M22
  157. Boeri L152
  158. Borges E153
  159. Gupte D154
  160. Gokalp F155
  161. Hebrard GH73
  162. Minhas S156
  163. Shah R114

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


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. © The Author(s), 2023.
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