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1. Controversy and consensus on indications for sperm DNA fragmentation testing in male infertility: A global survey, current guidelines, and expert recommendations

Author

Agarwal, Ashok, Farkouh, Ala'a, Saleh, Ramadan, Hamoda, Taha Abo-Almagd Abdel-Meguid, Harraz, Ahmed M., Kavoussi, Parviz, Arafa, Mohamed, and Palani, Ayad

Subjects
Delphi Method, Male Infertility, DNA Fragmentation, Practice Guidelines, Survey, Sperm
Abstract

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.

Published
2023

2. Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

Author

Shah, Rupin, Agarwal, Ashok, Kavoussi, Parviz, Rambhatla, Amarnath, Saleh, Ramadan, Cannarella, Rossella, Harraz, Ahmed M., Boitrelle, Florence, Kuroda, Shinnosuke, Hamoda, Taha Abo-Almagd Abdel-Meguid, Zini, Armand, Ko, Edmund, Çalık, Gökhan, Toprak, Tuncay, Kandil, Hussein, Gül, Murat, Bakırcıoğlu, Mustafa Emre, Parekh, Neel, Russo, Giorgio Ivan, Tadros, Nicholas, Kadıoğlu, Ateş, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotios, Malhotra, Vineet, Salvio, Gianmaria, Henkel, Ralf, Le, Tan V., Sogutdelen, Emrullah, Vij, Sarah, Alarbid, Abdullah, Güdeloğlu, Ahmet, Tsujimura, Akira, Calogero, Aldo E., El Meliegy, Amr, Crafa, Andrea, Kalkanlı, Arif, Baser, Aykut, Hazır, Berk, Giulioni, Carlo, Cho, Chak-Lam, Ho, Christopher C.K., Salzano, Ciro, Zylbersztejn, Daniel Suslik, Tien, Dung Mai Ba, Pescatori, Edoardo, Borges, Edson, Saïs-Hamza, Eminej, Huyghe, Eric, Ceyhan, Erman, Caroppo, Ettore, Castiglioni, Fabrizio, Bahar, Fahmi, Gökalp, Fatih, Lombardo, Francesco, Gadda, Franco, Duarsa, Gede Wirya Kusuma, Pinggera, Germar-Michael, Busetto, Gian Maria, Balercia, Giancarlo, Cito, Gianmartin, Blecher, Gideon, Franco, Giorgio, Liguori, Giovanni, Elbardisi, Haitham, Keskin, Hakan, Lin, Haocheng, Taniguchi, Hisanori, Park, Hyun Jun, Ziouziou, Imad, de la Rosette, Jean J. M. C. H., Hotaling, Jim, Ramsay, Jonathan, Molina, Juan Manuel Corral, Lo, Ka Lun, Böcü, Kadir, Khalafalla, Kareim, Bowa, Kasonde, Okada, Keisuke, Nagao, Koichi, Chiba, Koji, Hakim, Lukman, Makarounis, Konstantinos, Hehemann, Marah, Peña, Marcelo Rodriguez, Falcone, Marco, Bendayan, Marion, Martinez, Marlon, Timpano, Massimiliano, Altan, Mesut, Fode, Mikkel, Al-Marhoon, Mohamed S., Gilani, Mohammad Ali Sadighi, Soebadi, Mohammad Ayodhia, Gherabi, Nazim, Sofikitis, Nikolaos, Kahraman, Oğuzhan, Birowo, Ponco, Kothari, Priyank, Sindhwani, Puneet, Javed, Qaisar, Ambar, Rafael F., Kosgi, Raghavender, Ghayda, Ramy Abou, Adriansjah, Ricky, Condorelli, Rosita Angela, La Vignera, Sandro, Micic, Sava, Kim, Shannon Hee Kyung, Fukuhara, Shinichiro, Ahn, Sun Tae, Mostafa, Taymour, Ong, Teng Aik, Takeshima, Teppei, Amano, Toshiyasu, Barrett, Trenton, Arslan, Umut, Karthikeyan, Vilvapathy Senguttuvan, Atmoko, Widi, Yumura, Yasushi, Yuan, Yiming, Kato, Yuki, Jezek, Davor, Cheng, Bryan Kwun-Chung, Hatzichristodoulou, Georgios, Dy, Jun, Castañé, Eduard Ruiz, El-Sakka, Ahmed I., Nguyen, Quang, Sarıkaya, Selçuk, Boeri, Luca, Tan, Ronny, Moussa, Mohamad A., El-Assmy, Ahmed, Alali, Hamed, Alhathal, Naif, Osman, Yasser, Perovic, Dragoljub, Sajadi, Hesamoddin, Akhavizadegan, Hamed, Vučinić, Miroslav, Kattan, Said, Kattan, Mohamed S., Mogharabian, Nasser, Phuoc, Nguyen Ho Vinh, Ngoo, Kay Seong, Alkandari, Mohammad H., Alsuhaibani, Shaheed, Sokolakis, Ioannis, Babaei, Mehdi, King, Mak Siu, Diemer, Thorsten, Gava, Marcelo M., Henrique, Raphael, Spinola e Silva, Rodrigo, Paul, Gustavo Marquesine, Mierzwa, Tiago Cesar, Glina, Sidney, Siddiqi, Kashif, Wu, Han, Wurzacher, Jana, Farkouh, Ala'a, Son, Hwancheol, Minhas, Suks, Lee, Joe, Magsanoc, Nikko, Capogrosso, Paolo, Albano, German Jose, Lewis, Sheena E.M., Jayasena, Channa N., Alvarez, Juan G., Teo, Colin, Smith, Ryan P., Chua, Jo Ben M., Jensen, Christian Fuglesang S., Parekattil, Sijo, Finelli, Renata, Durairajanayagam, Damayanthi, Karna, Keshab Kumar, Ahmed, Abdelkareem, Evenson, Don, Umemoto, Yukihiro, Puigvert, Ana, Çeker, Gökhan, Colpi, Giovanni M., Rolitsky, Sarah, Bouzouita, Abderrazak, Shokeir, Ahmed, Aşçı, Ahmet, Bouker, Amin, Adamyan, Aram, Avoyan, Armen E., Palani, Ayad, Aghamajidi, Azin, Eze, Balantine, Noegroho, Bambang Sasongko, Purnomo, Basuki, Erkan, Bircan Kolbaşı, Zilaitiene, Birute, Kulaksız, Deniz, Kafetzis, Dimitrios, Lee, Dong Sup, Stember, Doron, Evgeni, Evangelini, Alhajeri, Faisal, Finocchi, Federica, Colombo, Fulvio, Tsangaris, George, Sallam, Hassan N., Acosta, Herik, Rosas, Israel Maldonado, Kirkman-Brown, Jackson, Shin, Jae Il, Sonksen, Jens, Dong, Jie, Marmar, Joel, Moreno-Sepulveda, Jose, Seo, Ju Tae, Aydos, Kaan, Kesari, Kavindra Kumar, Trost, Landon, Jenkins, Lawrence, Rocco, Lucia, Darbandi, Mahsa, Simopoulou, Mara, Alves, Marco, Sabbaghian, Marjan, Tavalaee, Marziyeh, Razi, Mazdak, Duran, Mesut Berkan, Nago, Mitsuru, Elkhouly, Mohamed, Khalili, Mohamed, Nasr-Esfahani, Mohammad Hossein, Kamath, Mohan S., Uğur, Muhammet Raşit, Park, Nam Cheol, Cruz, Natalio, Garrido, Nicolas, Sodeifi, Niloofar, Al Khalidi, Noora, Shoshany, Ohad, Satyagraha, Paksi, Drakopoulos, Panagiotos, Vogiatzi, Paraskevi, Dolati, Parisa, Das, Partha, Chiu, Peter Ka-Fung, Tsioulou, Petroula A., Patel, Premal, Singh, Rajender, Kaiyal, Raneen Sawaid, Santos, Ferreira, Dada, Rima, Brodjonegoro, Sakti, Banihani, Saleem Ali, Schon, Samantha, Darbandi, Sara, Güneş, Sezgin, Homa, Sheryl, Mutambirwa, Shingai, Roychoudhury, Shubhadeep, Diaz, Sofia Ines Leonardi, Gopalakrishnan, Sreelatha, Krawetz, Stephen, Jindal, Sunil, Avidor-Reiss, Tomer, Lin, Tsung Yen, Kumar, Vijay, Ibrahim, Wael, Kerkeni, Walid, Woo, Wongi, Morimoto, Yoshiharu, Cheng, Yu-Sheng, Shah, Rupin, Agarwal, Ashok, Kavoussi, Parviz, Rambhatla, Amarnath, Saleh, Ramadan, Cannarella, Rossella, Harraz, Ahmed M., Boitrelle, Florence, Kuroda, Shinnosuke, Hamoda, Taha Abo-Almagd Abdel-Meguid, Zini, Armand, Ko, Edmund, Calik, Gokhan, Toprak, Tuncay, Kandil, Hussein, Gül, Murat, Bakırcıoğlu, Mustafa Emre, Parekh, Neel, Russo, Giorgio Ivan, Tadros, Nichola, Kadioglu, Ate, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotio, Malhotra, Vineet, Salvio, Gianmaria, Henkel, Ralf, Le, Tan V., Sogutdelen, Emrullah, Vij, Sarah, Alarbid, Abdullah, Gudeloglu, Ahmet, Tsujimura, Akira, Calogero, Aldo E., Meliegy, Amr El, Crafa, Andrea, Kalkanli, Arif, Baser, Aykut, Hazir, Berk, Giulioni, Carlo, Cho, Chak-Lam, Ho, Christopher C. K., Salzano, Ciro, Zylbersztejn, Daniel Suslik, Tien, Dung Mai Ba, Pescatori, Edoardo, Borges, Edson, Serefoglu, Ege Can, Sas-Hamza, Emine, Huyghe, Eric, Ceyhan, Erman, Caroppo, Ettore, Castiglioni, Fabrizio, Bahar, Fahmi, Gokalp, Fatih, Lombardo, Francesco, Gadda, Franco, Duarsa, Gede Wirya Kusuma, Pinggera, Germar-Michael, Busetto, Gian Maria, Balercia, Giancarlo, Cito, Gianmartin, Blecher, Gideon, Franco, Giorgio, Liguori, Giovanni, Elbardisi, Haitham, Keskin, Hakan, Lin, Haocheng, Taniguchi, Hisanori, Park, Hyun Jun, Ziouziou, Imad, Rosette, Jean de la, Hotaling, Jim, Ramsay, Jonathan, Molina, Juan Manuel Corral, Lo, Ka Lun, Bocu, Kadir, Khalafalla, Kareim, Bowa, Kasonde, Okada, Keisuke, Nagao, Koichi, Chiba, Koji, Hakim, Lukman, Makarounis, Konstantino, Hehemann, Marah, Peña, Marcelo Rodriguez, Falcone, Marco, Bendayan, Marion, Martinez, Marlon, Timpano, Massimiliano, Altan, Mesut, Fode, Mikkel, Al-Marhoon, Mohamed S., Gilani, Mohammad Ali Sadighi, Soebadi, Mohammad Ayodhia, Gherabi, Nazim, Sofikitis, Nikolao, Kahraman, Oğuzhan, Birowo, Ponco, Kothari, Priyank, Sindhwani, Puneet, Javed, Qaisar, Ambar, Rafael F., Kosgi, Raghavender, Ghayda, Ramy Abou, Adriansjah, Ricky, Condorelli, Rosita Angela, Vignera, Sandro La, Micic, Sava, Kim, Shannon Hee Kyung, Fukuhara, Shinichiro, Ahn, Sun Tae, Mostafa, Taymour, Ong, Teng Aik, Takeshima, Teppei, Amano, Toshiyasu, Barrett, Trenton, Arslan, Umut, Karthikeyan, Vilvapathy Senguttuvan, Atmoko, Widi, Yumura, Yasushi, Yuan, Yiming, Kato, Yuki, Jezek, Davor, Cheng, Bryan Kwun-Chung, Hatzichristodoulou, Georgio, Dy, Jun, Castañé, Eduard Ruiz, El-Sakka, Ahmed I., Nguyen, Quang, Sarikaya, Selcuk, Boeri, Luca, Tan, Ronny, Moussa, Mohamad A., El-Assmy, Ahmed, Alali, Hamed, Alhathal, Naif, Osman, Yasser, Perovic, Dragoljub, Sajadi, Hesamoddin, Akhavizadegan, Hamed, Vučinić, Miroslav, Kattan, Said, Kattan, Mohamed S., Mogharabian, Nasser, Phuoc, Nguyen Ho Vinh, Ngoo, Kay Seong, Alkandari, Mohammad H., Alsuhaibani, Shaheed, Sokolakis, Ioanni, Babaei, Mehdi, King, Mak Siu, Diemer, Thorsten, Gava, Marcelo M., Henrique, Raphael, Silva, Rodrigo Spinola e, Paul, Gustavo Marquesine, Mierzwa, Tiago Cesar, Glina, Sidney, Siddiqi, Kashif, Wu, Han, Wurzacher, Jana, Farkouh, Ala’A, Son, Hwancheol, Minhas, Suk, Lee, Joe, Magsanoc, Nikko, Capogrosso, Paolo, Albano, German Jose, Lewis, Sheena E. M., Jayasena, Channa N., Alvarez, Juan G., Teo, Colin, Smith, Ryan P., Chua, Jo Ben M., Jensen, Christian Fuglesang S., Parekattil, Sijo, Finelli, Renata, Durairajanayagam, Damayanthi, Karna, Keshab Kumar, Ahmed, Abdelkareem, Evenson, Don, Umemoto, Yukihiro, Puigvert, Ana, Çeker, Gökhan, Forum, Giovanni M Colpi, Shah, R., Agarwal, A., Kavoussi, P., Rambhatla, A., Saleh, R., Cannarella, R., Harraz, A. M., Boitrelle, F., Kuroda, S., Hamoda, T. A. -A. A. -M., Zini, A., Ko, E., Calik, G., Toprak, T., Kandil, H., Gul, M., Bakircioglu, M. E., Parekh, N., Russo, G. I., Tadros, N., Kadioglu, A., Arafa, M., Chung, E., Rajmil, O., Dimitriadis, F., Malhotra, V., Salvio, G., Henkel, R., Le, T. V., Sogutdelen, E., Vij, S., Alarbid, A., Gudeloglu, A., Tsujimura, A., Calogero, A. E., El Meliegy, A., Crafa, A., Kalkanli, A., Baser, A., Hazir, B., Giulioni, C., Cho, C. -L., Ho, C. C. K., Salzano, C., Zylbersztejn, D. S., Tien, D. M. B., Pescatori, E., Borges, E., Serefoglu, E. C., Sais-Hamza, E., Huyghe, E., Ceyhan, E., Caroppo, E., Castiglioni, F., Bahar, F., Gokalp, F., Lombardo, F., Gadda, F., Duarsa, G. W. K., Pinggera, G. -M., Busetto, G. M., Balercia, G., Cito, G., Blecher, G., Franco, G., Liguori, G., Elbardisi, H., Keskin, H., Lin, H., Taniguchi, H., Park, H. J., Ziouziou, I., de la Rosette, J., Hotaling, J., Ramsay, J., Molina, J. M. C., Lo, K. L., Bocu, K., Khalafalla, K., Bowa, K., Okada, K., Nagao, K., Chiba, K., Hakim, L., Makarounis, K., Hehemann, M., Pena, M. R., Falcone, M., Bendayan, M., Martinez, M., Timpano, M., Altan, M., Fode, M., Al-Marhoon, M. S., Gilani, M. A. S., Soebadi, M. A., Gherabi, N., Sofikitis, N., Kahraman, O., Birowo, P., Kothari, P., Sindhwani, P., Javed, Q., Ambar, R. F., Kosgi, R., Ghayda, R. A., Adriansjah, R., Condorelli, R. A., La Vignera, S., Micic, S., Kim, S. H. K., Fukuhara, S., Ahn, S. T., Mostafa, T., Ong, T. A., Takeshima, T., Amano, T., Barrett, T., Arslan, U., Karthikeyan, V. S., Atmoko, W., Yumura, Y., Yuan, Y., Kato, Y., Jezek, D., Cheng, B. K. -C., Hatzichristodoulou, G., Dy, J., Castane, E. R., El-Sakka, A. I., Nguyen, Q., Sarikaya, S., Boeri, L., Tan, R., Moussa, M. A., El-Assmy, A., Alali, H., Alhathal, N., Osman, Y., Perovic, D., Sajadi, H., Akhavizadegan, H., Vucinic, M., Kattan, S., Kattan, M. S., Mogharabian, N., Phuoc, N. H. V., Ngoo, K. S., Alkandari, M. H., Alsuhaibani, S., Sokolakis, I., Babaei, M., King, M. S., Diemer, T., Gava, M. M., Henrique, R., Spinola e Silva, R., Paul, G. M., Mierzwa, T. C., Glina, S., Siddiqi, K., Wu, H., Wurzacher, J., Farkouh, A., Son, H., Minhas, S., Lee, J., Magsanoc, N., Capogrosso, P., Albano, G. J., Lewis, S. E. M., Jayasena, C. N., Alvarez, J. G., Teo, C., Smith, R. P., Chua, J. B. M., Jensen, C. F. S., Parekattil, S., Finelli, R., Durairajanayagam, D., Karna, K. K., Ahmed, A., Evenson, D., Umemoto, Y., Puigvert, A., Ceker, G., Colpi, G. M., Rolitsky, S., Bouzouita, A., Shokeir, A., Asci, A., Bouker, A., Adamyan, A., Avoyan, A. E., Palani, A., Aghamajidi, A., Eze, B., Noegroho, B. S., Purnomo, B., Erkan, B. K., Zilaitiene, B., Kulaksiz, D., Kafetzis, D., Lee, D. S., Stember, D., Evgeni, E., Alhajeri, F., Finocchi, F., Colombo, F., Tsangaris, G., Sallam, H. N., Acosta, H., Rosas, I. M., Kirkman-Brown, J., Shin, J. I., Sonksen, J., Dong, J., Marmar, J., Moreno-Sepulveda, J., Seo, J. T., Aydos, K., Kesari, K. K., Trost, L., Jenkins, L., Rocco, L., Darbandi, M., Simopoulou, M., Alves, M., Sabbaghian, M., Tavalaee, M., Razi, M., Duran, M. B., Nago, M., Elkhouly, M., Khalili, M., Nasr-Esfahani, M. H., Kamath, M. S., Ugur, M. R., Park, N. C., Cruz, N., Garrido, N., Sodeifi, N., Al Khalidi, N., Shoshany, O., Satyagraha, P., Drakopoulos, P., Vogiatzi, P., Dolati, P., Das, P., Chiu, P. K. -F., Tsioulou, P. A., Patel, P., Singh, R., Kaiyal, R. S., Santos, F., Dada, R., Brodjonegoro, S., Banihani, S. A., Schon, S., Darbandi, S., Gunes, S., Homa, S., Mutambirwa, S., Roychoudhury, S., Diaz, S. I. L., Gopalakrishnan, S., Krawetz, S., Jindal, S., Avidor-Reiss, T., Lin, T. Y., Kumar, V., Ibrahim, W., Kerkeni, W., Woo, W., Morimoto, Y., Cheng, Y. -S., and Tıp Fakültesi

Subjects
Aging, Consensus, Urology, INGUINAL VARICOCELECTOMY, Disease management, Male infertility, Survey, Varicocele, Consensu, Global Andrology Forum, Endocrinology & Metabolism, NONOBSTRUCTIVE AZOOSPERMIA, ASSISTED REPRODUCTIVE TECHNOLOGY, Male Infertility, Pharmacology (medical), Andrology, IMPAIRED SEMEN QUALITY, EUROPEAN ASSOCIATION, Science & Technology, UROLOGY GUIDELINES, Health Policy, Public Health, Environmental and Occupational Health, Disease Management, Urology & Nephrology, SUBCLINICAL VARICOCELE, Psychiatry and Mental health, Health Care Sciences & Services, MICROSURGICAL SUBINGUINAL VARICOCELECTOMY, Reproductive Medicine, SPERM MORPHOLOGY, UNTREATED VARICOCELE, Life Sciences & Biomedicine
Abstract

Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological As- sociation [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the re- sponses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identi- fied where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male in- fertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical prac- tice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Published
2022
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3. Sperm vitality and necrozoospermia: Diagnosis, management, and results of a global survey of clinical practice

Author

Agarwal, Ashok, Sharma, Rakesh K., Gupta, Sajal, Boitrelle, Florence, Finelli, Renata, Parekh, Neel, Durairajanayagam, Damayanthi, Saleh, Ramadan, Arafa, Mohamed, Cho, Chak Lam, Farkouh, Ala’a, Rambhatla, Amarnath, Henkel, Ralf, Vogiatzi, Paraskevi, Tadros, Nicholas, Kavoussi, Parviz, Ko, Edmund, Leisegang, Kristian, Kandil, Hussein, Palani, Ayad, Salvio, Gianmaria, Mostafa, Taymour, Rajmil, Osvaldo, Banihani, Saleem Ali, Schon, Samantha, Le, Tan V., Birowo, Ponco, Çeker, Gökhan, Alvarez, Juan, Molina, Juan Manuel Corral, Ho, Christopher C.K., Calogero, Aldo E., Khalafalla, Kareim, Duran, Mesut Berkan, Kuroda, Shinnosuke, Colpi, Giovanni M., Zini, Armand, Anagnostopoulou, Christina, Pescatori, Edoardo, Chung, Eric, Caroppo, Ettore, Dimitriadis, Fotios, Pinggera, Germar-Michael, Busetto, Gian Maria, Balercia, Giancarlo, Elbardisi, Haitham, Taniguchi, Hisanori, Park, Hyun Jun, Rosas, Israel Maldonado, de la Rosette, Jean J. M. C. H., Ramsay, Jonathan, Bowa, Kasonde, Simopoulou, Mara, Rodriguez, Marcelo Gabriel, Sabbaghian, Marjan, Martinez, Marlon, Gilani, Mohamed Ali Sadighi, Al-Marhoon, Mohamed S., Kosgi, Raghavender, Cannarella, Rossella, Micic, Sava, Fukuhara, Shinichiro, Parekattil, Sijo, Jindal, Sunil, Abdel-Meguid, Taha Abo-Almagd, Morimoto, Yoshiharu, and Shah, Rupin

Subjects
Nigrosin, endocrine system, urogenital system, Asthenozoospermia, Infertility, Eosine Yellowish-(YS), Vitality, Spermatozoa
Abstract

Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra -testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management. American Center for Reproductive Medicine

Published
2021

4. Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: a global survey, current guidelines, and expert recommendations

Author

Ala'a Farkouh, Ashok Agarwal, Taha Abo-Almagd Abdel-Meguid Hamoda, Parviz Kavoussi, Ramadan Saleh, Armand Zini, Mohamed Arafa, Ahmed M Harraz, Murat Gul, Vilvapathy Senguttuvan Karthikeyan, Damayanthi Durairajanayagam, Amarnath Rambhatla, Florence Boitrelle, Eric Chung, Ponco Birowo, Tuncay Toprak, Ramy Abou Ghayda, Rossella Cannarella, Nguyen Ho Vinh Phuoc, Fotios Dimitriadis, Giorgio I Russo, Ioannis Sokolakis, Taymour Mostafa, Konstantinos Makarounis, Imad Ziouziou, Shinnosuke Kuroda, Marion Bendayan, Raneen Sawaid Kaiyal, Andrian Japari 33, Mara Simopoulou 34, Lucia Rocco, Nicolas Garrido 36, Nazim Gherabi 37, Kadir Bocu 38, Oguzhan Kahraman 39, Tan V Le 27 28, Christine Wyns 40, Kelton Tremellen 41, Selcuk Sarikaya 42, Sheena Lewis 43, Donald P Evenson 44, Edmund Ko 45, Aldo E Calogero 25, Fahmi Bahar 46, Marlon Martinez 47, Andrea Crafa 25, Quang Nguyen 48 49, Rafael F Ambar 50 51, Giovanni Colpi 52, Mustafa Emre Bakircioglu 53, Ralf Henkel 54 55, Hussein Kandil 56, Ege Can Serefoglu 57, Abdullah Alarbid 13, Akira Tsujimura 58, Alireza Kheradmand 59, Christina Anagnostopoulou 60, Angelo Marino 61, Aram Adamyan 62, Birute Zilaitiene 63, Cevahir Ozer 39, Edoardo Pescatori 64, Paraskevi Vogiatzi 65, Gian Maria Busetto 66, Giancarlo Balercia 67, Haitham Elbardisi 9 10, Hamed Akhavizadegan 68, Hesamoddin Sajadi 69, Hisanori Taniguchi 70, Hyun Jun Park 71 72, Israel Maldonado Rosas 73, Mohamed Al-Marhoon 74, Mohammad Ali Sadighi Gilani 69, Naif Alhathal 75, Germar-Michael Pinggera 76, Priyank Kothari 77, Nasser Mogharabian 78, Sava Micic 79, Sheryl Homa 80, Sara Darbandi 81 82, Tran Quang Tien Long 83, Wael Zohdy 10, Widi Atmoko 22, Marjan Sabbaghian 69, Wael Ibrahim 84, Ryan P Smith 85, Christopher Chee Kong Ho 86, Jean de la Rosette 87, Ahmed I El-Sakka 88, Mirko Preto 89, Cătălina Zenoaga-Barbăroșie 90, Saad Mohammed Abumelha 91, Aykut Baser 92, Kaan Aydos 93, Liliana Ramirez-Dominguez 73, Vijay Kumar 94, Teng Aik Ong 95, Tiago Cesar Mierzwa 96, Ricky Adriansjah 97, Saleem A Banihani 98, Kasonde Bowa 99, Shinichiro Fukuhara 100, Marcelo Rodriguez Peña 101, Mohamad Moussa 102 103, Umut Çağın Ari 104, Chak-Lam Cho 105, Nicholas N Tadros 106, Muhammet Rasit Ugur 107, Edouard Amar 108, Marco Falcone 109, Frederic Romain Santer 76, Arif Kalkanli 110, Keshab Kumar Karna 111, Kareim Khalafalla 9 112 113, Ranjit B Vishwakarma 114, Federica Finocchi 67, Carlo Giulioni 115, Erman Ceyhan 39, Gökhan Çeker 116, Chadi Yazbeck 117, Osvaldo Rajmil 118, Mehmet Yilmaz 119, Baris Altay 120, Trenton L Barrett 121, Kay Seong Ngoo 122, Shubhadeep Roychoudhury 123, Gianmaria Salvio 67, Haocheng Lin 124, Ates Kadioglu 125, Massimiliano Timpano 109, Tomer Avidor-Reiss 126 127, Lukman Hakim 128, Puneet Sindhwani 128, Giorgio Franco 129, Rajender Singh 130, Filippo Giacone 131, Mikhail Ruzaev 132, Raghavender Kosgi 133, Nikolaos Sofikitis 134, Ayad Palani 135, Gokhan Calik 87, Deniz Kulaksız 136, Davor Jezek 137, Manaf Al Hashmi 138 139, Panagiotis Drakopoulos 140 141, Huda Omran 142, Sofia Leonardi 143, Ciler Celik-Ozenci 144, Nur Dokuzeylül Güngör 145, Jonathan Ramsay 146, Toshiyasu Amano 147, Emrullah Sogutdelen 148, Gede Wirya Kusuma Duarsa 149, Koji Chiba 150, Sunil Jindal 151, Missy Savira 22, Luca Boeri 152, Edson Borges 153, Deepak Gupte 154, Fatih Gokalp 155, Guadalupe Hernández Hebrard 73, Suks Minhas 156, Rupin Shah 114, Global Andrology Forum, Farkouh, Ala'A, Agarwal, Ashok, Abo-Almagd Abdel-Meguid Hamoda, Taha, Kavoussi, Parviz, Saleh, Ramadan, Zini, Armand, Arafa, Mohamed, M Harraz, Ahmed, Gul, Murat, Senguttuvan Karthikeyan, Vilvapathy, Durairajanayagam, Damayanthi, Rambhatla, Amarnath, Boitrelle, Florence, Chung, Eric, Birowo, Ponco, Toprak, Tuncay, Abou Ghayda, Ramy, Cannarella, Rossella, Ho Vinh Phuoc, Nguyen, Dimitriadis, Fotio, I Russo, Giorgio, Sokolakis, Ioanni, Mostafa, Taymour, Makarounis, Konstantino, Ziouziou, Imad, Kuroda, Shinnosuke, Bendayan, Marion, Sawaid Kaiyal, Raneen, Japari 33, Andrian, Simopoulou 34, Mara, Rocco, Lucia, Garrido 36, Nicola, Gherabi 37, Nazim, Bocu 38, Kadir, Kahraman 39, Oguzhan, V Le 27 28, Tan, Wyns 40, Christine, Tremellen 41, Kelton, Sarikaya 42, Selcuk, Lewis 43, Sheena, P Evenson 44, Donald, Ko 45, Edmund, E Calogero 25, Aldo, Bahar 46, Fahmi, Martinez 47, Marlon, Crafa 25, Andrea, Nguyen 48 49, Quang, F Ambar 50 51, Rafael, Colpi 52, Giovanni, Emre Bakircioglu 53, Mustafa, Henkel 54 55, Ralf, Kandil 56, Hussein, Can Serefoglu 57, Ege, Alarbid 13, Abdullah, Tsujimura 58, Akira, Kheradmand 59, Alireza, Anagnostopoulou 60, Christina, Marino 61, Angelo, Adamyan 62, Aram, Zilaitiene 63, Birute, Ozer 39, Cevahir, Pescatori 64, Edoardo, Vogiatzi 65, Paraskevi, Maria Busetto 66, Gian, Balercia 67, Giancarlo, 9 10, Haitham Elbardisi, Akhavizadegan 68, Hamed, Sajadi 69, Hesamoddin, Taniguchi 70, Hisanori, Jun Park 71 72, Hyun, Maldonado Rosas 73, Israel, Al-Marhoon 74, Mohamed, Ali Sadighi Gilani 69, Mohammad, Alhathal 75, Naif, Pinggera 76, Germar-Michael, Kothari 77, Priyank, Mogharabian 78, Nasser, Micic 79, Sava, Homa 80, Sheryl, Darbandi 81 82, Sara, Quang Tien Long 83, Tran, Zohdy 10, Wael, Atmoko 22, Widi, Sabbaghian 69, Marjan, Ibrahim 84, Wael, P Smith 85, Ryan, Chee Kong Ho 86, Christopher, de la Rosette 87, Jean, I El-Sakka 88, Ahmed, Preto 89, Mirko, Zenoaga-Barbăroșie 90, Cătălina, Mohammed Abumelha 91, Saad, Baser 92, Aykut, Aydos 93, Kaan, Ramirez-Dominguez 73, Liliana, Kumar 94, Vijay, Aik Ong 95, Teng, Cesar Mierzwa 96, Tiago, Adriansjah 97, Ricky, A Banihani 98, Saleem, Bowa 99, Kasonde, Fukuhara 100, Shinichiro, Rodriguez Peña 101, Marcelo, Moussa 102 103, Mohamad, Çağın Ari 104, Umut, Cho 105, Chak-Lam, N Tadros 106, Nichola, Rasit Ugur 107, Muhammet, Amar 108, Edouard, Falcone 109, Marco, Romain Santer 76, Frederic, Kalkanli 110, Arif, Kumar Karna 111, Keshab, 9 112 113, Kareim Khalafalla, B Vishwakarma 114, Ranjit, Finocchi 67, Federica, Giulioni 115, Carlo, Ceyhan 39, Erman, Çeker 116, Gökhan, Yazbeck 117, Chadi, Rajmil 118, Osvaldo, Yilmaz 119, Mehmet, Altay 120, Bari, L Barrett 121, Trenton, Seong Ngoo 122, Kay, Roychoudhury 123, Shubhadeep, Salvio 67, Gianmaria, Lin 124, Haocheng, Kadioglu 125, Ate, Timpano 109, Massimiliano, Avidor-Reiss 126 127, Tomer, Hakim 128, Lukman, Sindhwani 128, Puneet, Franco 129, Giorgio, Singh 130, Rajender, Giacone 131, Filippo, Ruzaev 132, Mikhail, Kosgi 133, Raghavender, Sofikitis 134, Nikolao, Palani 135, Ayad, Calik 87, Gokhan, Kulaksız 136, Deniz, Jezek 137, Davor, Al Hashmi 138 139, Manaf, Drakopoulos 140 141, Panagioti, Omran 142, Huda, Leonardi 143, Sofia, Celik-Ozenci 144, Ciler, Dokuzeylül Güngör 145, Nur, Ramsay 146, Jonathan, Amano 147, Toshiyasu, Sogutdelen 148, Emrullah, Wirya Kusuma Duarsa 149, Gede, Chiba 150, Koji, Jindal 151, Sunil, Savira 22, Missy, Boeri 152, Luca, Borges 153, Edson, Gupte 154, Deepak, Gokalp 155, Fatih, Hernández Hebrard 73, Guadalupe, Minhas 156, Suk, Shah 114, Rupin, and Andrology Forum, Global

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.

Published
2023

5. Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Author

Agarwal, A, Farkouh, A, Saleh, R, Abdel-Meguid Hamoda, TA-A, Harraz, AM, Kavoussi, P, Arafa, M, Salvio, G, Rambhatla, A, Toprak, T, Gül, M, Phuoc, NHV, Boitrelle, F, Birowo, P, Ghayda, RA, Cannarella, R, Kuroda, S, Durairajanayagam, D, Zini, A, Wyns, C, Sarikaya, S, Tremellen, K, Mostafa, T, Sokolakis, I, Evenson, DP, Henkel, R, Zohdy, W, Chung, E, Ziouziou, I, Falcone, M, Russo, GI, Al-Hashimi, M, Calogero, AE, Ko, E, Colpi, G, Lewis, S, Serefoglu, EC, Bahar, F, Martinez, M, Nguyen, Q, Ambar, RF, Bakircioglu, ME, Kandil, H, Mogharabian, N, Sabbaghian, M, Taniguchi, H, Tsujimura, A, Sajadi, H, Ibrahim, W, Atmoko, W, Vogiatzi, P, Gunes, S, Gilani, MAS, Roychoudhury, S, Güngör, ND, Hakim, L, Adriansjah, R, Kothari, P, Jindal, S, Amar, E, Park, HJ, Long, TQT, Homa, S, Karthikeyan, VS, Zilaitiene, B, Rosas, IM, Marino, A, Pescatori, E, Ozer, C, Akhavizadegan, H, Garrido, N, Busetto, GM, Adamyan, A, Al-Marhoon, M, Elbardisi, H, Dolati, P, Darbandi, M, Darbandi, S, Balercia, G, Pinggera, G-M, Micic, S, Ho, CCK, Moussa, M, Preto, M, Zenoaga-Barbăroșie, C, Smith, RP, Kosgi, R, Rosette, JDL, El-Sakka, AI, Abumelha, SM, Mierzwa, TC, Ong, TA, Banihani, SA, Bowa, K, Fukuhara, S, Boeri, L, Danacıoğlu, YO, Gokalp, F, Selim, OM, Cho, C-L, Tadros, NN, Ugur, MR, Ozkent, MS, Chiu, P, Kalkanli, A, Khalafalla, K, Vishwakarma, RB, Finocchi, F, Andreadakis, S, Giulioni, C, Çeker, G, Ceyhan, E, Malhotra, V, Yilmaz, M, Timpano, M, Barrett, TL, Kim, SHK, Ahn, S-T, Giacone, F, Palani, A, Duarsa, GWK, Kadioglu, A, Gadda, F, Zylbersztejn, DS, Aydos, K, Kulaksız, D, Gupte, D, Calik, G, Karna, KK, Drakopoulos, P, Baser, A, Kumar, V, Molina, JMC, Rajmil, O, Ferreira, RH, Leonardi, S, Avoyan, A, Sogutdelen, E, Franco, G, Ramsay, J, Ramirez, L, Shah, R, Global Andrology Forum, Agarwal, Ashok, Farkouh, Ala'A, Saleh, Ramadan, Abdel-Meguid Hamoda, Taha Abo-Almagd, Harraz, Ahmed M, Kavoussi, Parviz, Arafa, Mohamed, Salvio, Gianmaria, Rambhatla, Amarnath, Toprak, Tuncay, Gül, Murat, Phuoc, Nguyen Ho Vinh, Boitrelle, Florence, Birowo, Ponco, Ghayda, Ramy Abou, Cannarella, Rossella, Kuroda, Shinnosuke, Durairajanayagam, Damayanthi, Zini, Armand, Wyns, Christine, Sarikaya, Selcuk, Tremellen, Kelton, Mostafa, Taymour, Sokolakis, Ioanni, Evenson, Donald P, Henkel, Ralf, Zohdy, Wael, Chung, Eric, Ziouziou, Imad, Falcone, Marco, Russo, Giorgio I, Al-Hashimi, Manaf, Calogero, Aldo E, Ko, Edmund, Colpi, Giovanni, Lewis, Sheena, Serefoglu, Ege Can, Bahar, Fahmi, Martinez, Marlon, Nguyen, Quang, Ambar, Rafael F, Bakircioglu, Mustafa Emre, Kandil, Hussein, Mogharabian, Nasser, Sabbaghian, Marjan, Taniguchi, Hisanori, Tsujimura, Akira, Sajadi, Hesamoddin, Ibrahim, Wael, Atmoko, Widi, Vogiatzi, Paraskevi, Gunes, Sezgin, Gilani, Mohammad Ali Sadighi, Roychoudhury, Shubhadeep, Güngör, Nur Dokuzeylül, Hakim, Lukman, Adriansjah, Ricky, Kothari, Priyank, Jindal, Sunil, Amar, Edouard, Park, Hyun Jun, Long, Tran Quang Tien, Homa, Sheryl, Karthikeyan, Vilvapathy Senguttuvan, Zilaitiene, Birute, Rosas, Israel Maldonado, Marino, Angelo, Pescatori, Edoardo, Ozer, Cevahir, Akhavizadegan, Hamed, Garrido, Nicola, Busetto, Gian Maria, Adamyan, Aram, Al-Marhoon, Mohamed, Elbardisi, Haitham, Dolati, Parisa, Darbandi, Mahsa, Darbandi, Sara, Balercia, Giancarlo, Pinggera, Germar-Michael, Micic, Sava, Ho, Christopher Chee Kong, Moussa, Mohamad, Preto, Mirko, Zenoaga-Barbăroșie, Cătălina, Smith, Ryan P, Kosgi, Raghavender, Rosette, Jean de la, El-Sakka, Ahmed I, Abumelha, Saad Mohammed, Mierzwa, Tiago Cesar, Ong, Teng Aik, Banihani, Saleem A, Bowa, Kasonde, Fukuhara, Shinichiro, Boeri, Luca, Danacıoğlu, Yavuz Onur, Gokalp, Fatih, Selim, Osama Mohamed, Cho, Chak-Lam, Tadros, Nicholas N, Ugur, Muhammet Rasit, Ozkent, Mehmet Serkan, Chiu, Peter, Kalkanli, Arif, Khalafalla, Kareim, Vishwakarma, Ranjit B, Finocchi, Federica, Andreadakis, Sotiri, Giulioni, Carlo, Çeker, Gökhan, Ceyhan, Erman, Malhotra, Vineet, Yilmaz, Mehmet, Timpano, Massimiliano, Barrett, Trenton L, Kim, Shannon Hee Kyung, Ahn, Sun-Tae, Giacone, Filippo, Palani, Ayad, Duarsa, Gede Wirya Kusuma, Kadioglu, Ate, Gadda, Franco, Zylbersztejn, Daniel Suslik, Aydos, Kaan, Kulaksız, Deniz, Gupte, Deepak, Calik, Gokhan, Karna, Keshab Kumar, Drakopoulos, Panagioti, Baser, Aykut, Kumar, Vijay, Molina, Juan Manuel Corral, Rajmil, Osvaldo, Ferreira, Raphael H, Leonardi, Sofia, Avoyan, Armen, Sogutdelen, Emrullah, Franco, Giorgio, Ramsay, Jonathan, Ramirez, Liliana, Shah, Rupin, and Rocco, Lucia

Subjects
Male infertility, Practice guideline, Delphi method, DNA fragmentation, Survey, Sperm
Abstract

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.

Published
2023

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