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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

2023; Korean Society for Sexual Medicine and Andrology; Volume: 41; Issue: 3 Linguagem: Inglês

10.5534/wjmh.220282

2287-4690

Ashok Agarwal, Ala’a Farkouh, Ramadan Saleh, Taha Abo-Almagd Abdel-Meguid Hamoda, ‬Ahmed M. Harraz, Parviz K. Kavoussi, Mohamed Arafa, Gianmaria Salvio, Amarnath Rambhatla, Tuncay Toprak, Murat Gül, Nguyen Ho Vinh Phuoc, Florence Boitrelle, Ponco Birowo, Ramy Abou Ghayda, Rossella Cannarella, Shinnosuke Kuroda, Damayanthi Durairajanayagam, Armand Zini, Christine Wyns, Selçuk Sarıkaya, Kelton Tremellen, Taymour Mostafa, Ioannis Sokolakis, Donald P. Evenson, Ralf Henkel, Wael Zohdy, Eric Chung, Imad Ziouziou, Marco Falcone, Giorgio Ivan Russo, Manaf Al Hashimi, Aldo E. Calogero, Edmund Ko, Giovanni M. Colpi, Sheena Lewis, Ege Can Şerefoğlu, Fahmi Bahar, Marlon Martínez, Quang Nguyen, Rafael F. Ambar, Emre Bakırcıoğlu, Hussein Kandil, Nasser Mogharabian, Marjan Sabbaghian, Hisanori Taniguchi, Akira Tsujimura, Hesamoddin Sajadi, Wael Ibrahim, Widi Atmoko, Paraskevi Vogiatzi, Sezgin Güneş, Mohammad Ali Sadighi Gilani, Shubhadeep Roychoudhury, Nur DOKUZEYLÜL GÜNGÖR, Lukman Hakim, Ricky Adriansjah, Priyank Kothari, Sunil Jindal, Edouard Amar, Hyun Jun Park, Tran Quang Tien Long, Sheryl T. Homa, Vilvapathy Senguttuvan Karthikeyan, Birutė Žilaitienė, Israel Maldonado Rosas, Angelo Marino, Edoardo Pescatori, Cevahir Özer, Hamed Akhavizadegan, Nicolás Garrido, Gian Maria Busetto, Aram Adamyan, Mohamed S. Al‐Marhoon, Haitham Elbardisi, Parisa Dolati, Mahsa Darbandi, Sara Darbandi, Giancarlo Balercia, Germar‐Michael Pinggera, S. Mičić, Christopher C.K. Ho, Mohamad Moussa, Mirko Preto, Cătălina Zenoaga-Barbăroșie, Ryan P. Smith, Raghavender Kosgi, Jean de la Rosette, Ahmed I. El‐Sakka, Saad Abumelha, Tiago César Mierzwa, Teng Aik Ong, Saleem Ali Banihani, Kasonde Bowa, Shinichiro Fukuhara, Luca Boeri, Yavuz Onur Danacıoğlu, Fatih Gökalp, Osama Mohamed Selim, Chak‐Lam Cho, Nicholas N. Tadros, Muhammet Rasit Ugur, Mehmet Serkan Özkent, Peter Ka‐Fung Chiu, Arif Kalkanlı, Kareim Khalafalla, Ranjit B. Vishwakarma, Federica Finocchi, Sotiris Andreadakis, Carlo Giulioni, Gökhan Çeker, Erman Ceyhan, Vineet Malhotra, Mehmet Yılmaz, M. Timpano, Trenton Barrett, Shannon Hee Kyung Kim, Sun Tae Ahn, Filippo Giacone, Ayad Palani, Gede Wirya Kusuma Duarsa, Ateş Kadıoğlu, Franco Gadda, Daniel Suslik Zylbersztejn, Kaan Aydos, Deniz Kulaksız, Deepak Gupte, Gökhan Çalık, Keshab Kumar Karna, Panagiotis Drakopoulos, Aykut Başer, Vijay Kumar, Juan Manuel Corral Molina, Osvaldo Rajmil, Raphael Henrique Ferreira, Sofia Leonardi, Armen Avoyan, Emrullah Söğütdelen, Giorgio Franco, Jonathan Ramsay, Liliana Berenice Ramirez Dominguez, Rupin Shah,

Reproductive Biology and Fertility

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.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.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.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.