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KMID : 1037120230410030575
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The World Journal of Men′s Health
2023 Volume.41 No. 3 p.575 ~ p.602
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Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
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Ashok Agarwal
Ala’a Farkouh
Ramadan Saleh
Taha Abo-Almagd Abdel-Meguid Hamoda
Ahmed M. Harraz
Yinan Li
Mohamed Arafa
Gianmaria Salvio
Guiming Wang
Tuncay Toprak
Murat Gul
Nguyen Ho Vinh Phuoc
Florence Boitrelle
Ponco Birowo
Ramy Abou Ghayda
Rossella Cannarella
Shinnosuke Kuroda
Damayanthi Durairajanayagam
Lee Moon-Ok
Christine Wyns
Selcuk Sarikaya
Kelton Tremellen
Taymour Mostafa
Ioannis Sokolakis
Jung Eun-Sun
Ralf Henkel
Wael Zohdy
Eric Chung
Imad Ziouziou
Marco Falcone
Giorgio I. Russo
Manaf Al-Hashimi
Aldo E. Calogero
Edmund Ko
Giovanni Colpi
Sheena Lewis
Ege Can Serefoglu
Fahmi Bahar
Marlon Martinez
Lee Hye-Won
Rafael F. Ambar
Mustafa Emre Bakircioglu
Hussein Kandil
Nasser Mogharabian
Marjan Sabbaghian
Hisanori Taniguchi
Akira Tsujimura
Hesamoddin Sajadi
Wael Ibrahim
Widi Atmoko
Paraskevi Vogiatzi
Sezgin Gunes
Mohammad Ali Sadighi Gilani
Shubhadeep Roychoudhury
Nur Dokuzeylul Gungor
Lukman Hakim
Ricky Adriansjah
Priyank Kothari
Sunil Jindal
Kang Hyun
Hyun Jun Park
Tran Quang Tien Long
Sheryl Homa
Vilvapathy Senguttuvan Karthikeyan
Birute Zilaitiene
Israel Maldonado Rosas
Angelo Marino
Edoardo Pescatori
Cevahir Ozer
Hamed Akhavizadegan
Nicolas Garrido
Gian Maria Busetto
Aram Adamyan
Mohamed Al-Marhoon
Haitham Elbardisi
Parisa Dolati
Mahsa Darbandi
Sara Darbandi
Giancarlo Balercia
Germar-Michael Pinggera
Sava Micic
Christopher Chee Kong Ho
Mohamad Moussa
Mirko Preto
Catalina Zenoaga-Barbarosie
Ryan P. Smith
Raghavender Kosgi
Jean de la Rosette
Shin Young-Min
Saad Mohammed Abumelha
Tiago Cesar Mierzwa
Teng Aik Ong
Saleem A. Banihani
Choi Yoon-Young
Shinichiro Fukuhara
Luca Boeri
Yavuz Onur Danacıoglu
Fatih Gokalp
Osama Mohamed Selim
Chak-Lam Cho
Sung Ji-Yong
Muhammet Rasit Ugur
Mehmet Serkan Ozkent
Peter Chiu
Arif Kalkanli
Kareim Khalafalla
Ranjit B. Vishwakarma
Federica Finocchi
Sotiris Andreadakis
Carlo Giulioni
Gokhan ceker
Erman Ceyhan
Vineet Malhotra
Mehmet Yilmaz
Massimiliano Timpano
Trenton L. Barrett
Shannon Hee Kyung Kim
Ahn Sun-Tae
Filippo Giacone
Lee Min-Young
Gede Wirya Kusuma Duarsa
Ates Kadioglu
Franco Gadda
Daniel Suslik Zylbersztejn
Kaan Aydos
Deniz Kulaksız
Deepak Gupte
Gokhan Calik
Keshab Kumar Karna
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Abstract
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Purpose : Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations.
Materials and Methods : Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus.
Results : The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing.
Conclusions : This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.
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KEYWORD
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Delphi method, DNA fragmentation, Male infertility, Practice guidelines, Sperm, Survey
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