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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, 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

5. Antisperm Antibody Testing: A Comprehensive Review of Its Role in the Management of Immunological Male Infertility and Results of a Global Survey of Clinical Practices

Author

Sajal Gupta, Rakesh Sharma, Ashok Agarwal, Florence Boitrelle, Renata Finelli, Ala'a Farkouh, Ramadan Saleh, Taha Abo-Almagd Abdel-Meguid, Murat Gül, Birute Zilaitiene, Edmund Ko, Amarnath Rambhatla, Armand Zini, Kristian Leisegang, Shinnosuke Kuroda, Ralf Henkel, Rossella Cannarella, Ayad Palani, Chak-Lam Cho, Christopher C.K. Ho, Daniel Suslik Zylbersztejn, Edoardo Pescatori, Eric Chung, Fotios Dimitriadis, Germar-Michael Pinggera, Gian Maria Busetto, Giancarlo Balercia, Gianmaria Salvio, Giovanni M. Colpi, Gökhan Çeker, Hisanori Taniguchi, Hussein Kandil, Hyun Jun Park, Israel Maldonado Rosas, Jean de la Rosette, Joao Paulo Greco Cardoso, Jonathan Ramsay, Juan Alvarez, Juan Manuel Corral Molina, Kareim Khalafalla, Kasonde Bowa, Kelton Tremellen, Evangelini Evgeni, Lucia Rocco, Marcelo Gabriel Rodriguez Peña, Marjan Sabbaghian, Marlon Martinez, Mohamed Arafa, Mohamed S. Al-Marhoon, Nicholas Tadros, Nicolas Garrido, Osvaldo Rajmil, Pallav Sengupta, Paraskevi Vogiatzi, Parviz Kavoussi, Ponco Birowo, Raghavender Kosgi, Saleem Bani-Hani, Sava Micic, Sijo Parekattil, Sunil Jindal, Tan V. Le, Taymour Mostafa, Tuncay Toprak, Yoshiharu Morimoto, Vineet Malhotra, Azin Aghamajidi, Damayanthi Durairajanayagam, Rupin Shah, Gupta, S., Sharma, R., Agarwal, A., Boitrelle, F., Finelli, R., Farkouh, A., Saleh, R., Abdel-Meguid, T. A. -A., Gul, M., Zilaitiene, B., Ko, E., Rambhatla, A., Zini, A., Leisegang, K., Kuroda, S., Henkel, R., Cannarella, R., Palani, A., Cho, C. -L., Ho, C. C. K., Zylbersztejn, D. S., Pescatori, E., Chung, E., Dimitriadis, F., Pinggera, G. -M., Busetto, G. M., Balercia, G., Salvio, G., Colpi, G. M., Ceker, G., Taniguchi, H., Kandil, H., Park, H. J., Rosas, I. M., de la Rosette, J., Cardoso, J. P. G., Ramsay, J., Alvarez, J., Molina, J. M. C., Khalafalla, K., Bowa, K., Tremellen, K., Evgeni, E., Rocco, L., Pena, M. G. R., Sabbaghian, M., Martinez, M., Arafa, M., Al-Marhoon, M. S., Tadros, N., Garrido, N., Rajmil, O., Sengupta, P., Vogiatzi, P., Kavoussi, P., Birowo, P., Kosgi, R., Bani-Hani, S., Micic, S., Parekattil, S., Jindal, S., Le, T. V., Mostafa, T., Toprak, T., Morimoto, Y., Malhotra, V., Aghamajidi, A., Durairajanayagam, D., and Shah, R.

Subjects
Aging, Urology, Antibodie, DIAGNOSIS, Antibodies, Endocrinology & Metabolism, male, FERTILIZATION, FERTILITY, Pharmacology (medical), Andrology, Survey, PREDNISOLONE TREATMENT, COUPLES, Science & Technology, Health Policy, Public Health, Environmental and Occupational Health, CHRONIC PROSTATITIS, Urology & Nephrology, SEMEN PARAMETERS, Infertility, male, Sperm agglutination, Spermatozoa, digestive system diseases, Psychiatry and Mental health, PREGNANCY RATES, Health Care Sciences & Services, surgical procedures, operative, Reproductive Medicine, Infertility, SPERM AUTOANTIBODIES, Life Sciences & Biomedicine, SUBFERTILE MEN
Abstract

Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the immune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relationship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this article, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for assessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are presented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.

Published
2022

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

Author

Agarwal A, Farkouh A, Saleh R, Hamoda TAA, Salvio G, Boitrelle F, Harraz AM, Ghayda RA, Kavoussi P, Gül M, Toprak T, Russo GI, Durairajanayagam D, Rambhatla A, Birowo P, Cannarella R, Phuoc NHV, Zini A, Arafa M, Wyns C, Tremellen K, Sarıkaya S, Lewis S, Evenson DP, Ko E, Calogero AE, Bahar F, Martínez M, Ambar RF, Colpi GM, Bakircioglu ME, Henkel R, Kandil H, Serefoglu EC, Alfakhri A, Tsujimura A, Kheradmand A, Marino A, Adamyan A, Zilaitiene B, Ozer C, Pescatori E, Vogiatzi P, Busetto GM, Balercia G, Elbardisi H, Akhavizadegan H, Sajadi H, Taniguchi H, Park HJ, Maldonado Rosas I, Al-Marhoon M, Sadighi Gilani MA, Alhathal N, Quang N, Pinggera GM, Kothari P, Micic S, Homa S, Long TQT, Zohdy W, Atmoko W, Ibrahim W, Sabbaghian M, Abumelha SM, Chung E, Ugur MR, Ozkent MS, Selim O, Darbandi M, Fukuhara S, Jamali M, de la Rosette J, Kuroda S, Smith RP, Baser A, Kalkanli A, Tadros NN, Aydos K, Mierzwa TC, Khalafalla K, Malhotra V, Moussa M, Finocchi F, Rachman RI, Giulioni C, Avidor-Reiss T, Kahraman O, Çeker G, Zenoaga-Barbăroșie C, Barrett TL, Yilmaz M, Kadioglu A, Jindal S, Omran H, Bocu K, Karthikeyan VS, Franco G, Solorzano JF, Vishwakarma RB, Arianto E, Garrido N, Jain D, Gherabi N, Sokolakis I, Palani A, Calik G, Kulaksiz D, Simanaviciene V, Simopoulou M, Güngör ND, Blecher G, Falcone M, Jezek D, Preto M, Amar E, Le TV, Ahn ST, Rezano A, Singh K, Rocco L, Savira M, Rajmil O, Darbandi S, Sogutdelen E, Boeri L, Hernández G, Hakim L, Morimoto Y, Japari A, Sofikitis N, Altay B, Metin Mahmutoglu A, Al Hashimi M, Ziouziou I, Anagnostopoulou C, Lin H, and Shah R

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., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Published
2024
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7. Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.

Author

Farkouh A, Agarwal A, Hamoda TAA, Kavoussi P, Saleh R, Zini A, Arafa M, Harraz AM, Gul M, Karthikeyan VS, Durairajanayagam D, Rambhatla A, Boitrelle F, Chung E, Birowo P, Toprak T, Ghayda RA, Cannarella R, Phuoc NHV, Dimitriadis F, Russo GI, Sokolakis I, Mostafa T, Makarounis K, Ziouziou I, Kuroda S, Bendayan M, Kaiyal RS, Japari A, Simopoulou M, Rocco L, Garrido N, Gherabi N, Bocu K, Kahraman O, Le TV, Wyns C, Tremellen K, Sarikaya S, Lewis S, Evenson DP, Ko E, Calogero AE, Bahar F, Martinez M, Crafa A, Nguyen Q, Ambar RF, Colpi G, Bakircioglu ME, Henkel R, Kandil H, Serefoglu EC, Alarbid A, Tsujimura A, Kheradmand A, Anagnostopoulou C, Marino A, Adamyan A, Zilaitiene B, Ozer C, Pescatori E, Vogiatzi P, Busetto GM, Balercia G, Elbardisi H, Akhavizadegan H, Sajadi H, Taniguchi H, Park HJ, Maldonado Rosas I, Al-Marhoon M, Sadighi Gilani MA, Alhathal N, Pinggera GM, Kothari P, Mogharabian N, Micic S, Homa S, Darbandi S, Long TQT, Zohdy W, Atmoko W, Sabbaghian M, Ibrahim W, Smith RP, Ho CCK, de la Rosette J, El-Sakka AI, Preto M, Zenoaga-Barbăroșie C, Abumelha SM, Baser A, Aydos K, Ramirez-Dominguez L, Kumar V, Ong TA, Mierzwa TC, Adriansjah R, Banihani SA, Bowa K, Fukuhara S, Rodriguez Peña M, Moussa M, Ari UÇ, Cho CL, Tadros NN, Ugur MR, Amar E, Falcone M, Santer FR, Kalkanli A, Karna KK, Khalafalla K, Vishwakarma RB, Finocchi F, Giulioni C, Ceyhan E, Çeker G, Yazbeck C, Rajmil O, Yilmaz M, Altay B, Barrett TL, Ngoo KS, Roychoudhury S, Salvio G, Lin H, Kadioglu A, Timpano M, Avidor-Reiss T, Hakim L, Sindhwani P, Franco G, Singh R, Giacone F, Ruzaev M, Kosgi R, Sofikitis N, Palani A, Calik G, Kulaksız D, Jezek D, Al Hashmi M, Drakopoulos P, Omran H, Leonardi S, Celik-Ozenci C, Güngör ND, Ramsay J, Amano T, Sogutdelen E, Duarsa GWK, Chiba K, Jindal S, Savira M, Boeri L, Borges E, Gupte D, Gokalp F, Hebrard GH, Minhas S, and Shah R

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., Competing Interests: The authors have nothing to disclose., (Copyright © 2023 Korean Society for Sexual Medicine and Andrology.)

Published
2023
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8. 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, 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, Sadighi Gilani MA, Roychoudhury S, Güngör ND, Hakim L, Adriansjah R, Kothari P, Jindal S, Amar E, Park HJ, Long TQT, Homa S, Karthikeyan VS, Zilaitiene B, Maldonado Rosas I, 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 GM, Micic S, Ho CCK, Moussa M, Preto M, Zenoaga-Barbăroșie C, Smith RP, Kosgi R, de la Rosette J, El-Sakka AI, Abumelha SM, Mierzwa TC, Ong TA, Banihani SA, Bowa K, Fukuhara S, Boeri L, Danacıoğlu YO, Gokalp F, Selim OM, Cho CL, 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 ST, 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, and Shah R

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., Competing Interests: The authors have nothing to disclose., (Copyright © 2023 Korean Society for Sexual Medicine and Andrology.)

Published
2023
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10. Comparison of the demographics, semen parameters and hormone profiles in men with primary and secondary infertility.

Author

Gowri V, Venkiteswaran KP, Al-Zakwani I, Mathew J, Rahman KA, and Al-Marhoon M

Abstract

Objectives: The objectives of this study were to compare the demographics, semen parameters and hormone profiles in men with primary and secondary infertility., Methods: The study was designed as a retrospective analysis of data collected from men attending a combined infertility clinic (seen together by urologist and gynaecologist) from January 2005 to December 2008 at Sultan Qaboos University Hospital, a tertiary care hospital in Oman. Ninety-eight consecutive male patients with one or more abnormalities in semen analysis were referred to the combined infertility clinic. A complete physical examination was carried out by a urologist followed by hormone evaluation of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and prolactin (PRL)., Results: The semen parameters and the sex hormone evaluation were not significantly different between the men with primary and secondary infertility. The men with primary infertility were younger than the men with secondary infertility. A total of 24% of the men in the primary group and 16% in the secondary group were azoospermic with normal gonadotropin values in 9 men and 1 man in the primary and secondary group respectively., Conclusion: Azoospermia was more common in the primary infertile group and, based on gonadotropin levels, obstructive causes seemed more prevalent in the primary group compared to secondary group.

Published
2010

11. Laparoscopic deroofing of large renal simple cysts causing gastric symptoms.

Author

Mathew J, Al-Marhoon M, Machado N, William R, and Rahman K

Abstract

Widespread use of ultrasonography and computerized tomography of the abdomen result in the detection of a large number of renal mass lesions. Most of these are simple renal cysts, which do not need any further evaluation or follow up unless symptomatic. Simple renal cysts can be diagnosed with certainty if the treating physician or surgeon is aware of these features and can avoid unnecessary urology referral, patient anxiety, inconvenience and expense. Symptomatic cysts and complex renal cysts need further evaluation and intervention. We present the case of large symptomatic renal cysts persisting after aspiration sclerotherapy, which were managed by deroofing the cyst laparoscopically. Laparoscopic deroofing is rapidly becoming accepted as the surgical intervention of choice for symptomatic renal cysts persisting after aspiration sclerotherapy.

Published
2007

12. Primary localized AA type amyloidosis of urinary bladder: case report of rare cause of episodic painless hematuria.

Author

Akram CM, Al-Marhoon MS, Mathew J, Grant CS, and Rao TV

Subjects
Amyloidosis diagnosis, Amyloidosis metabolism, Biopsy, Cystoscopy, Diagnosis, Differential, Follow-Up Studies, Hematuria diagnosis, Hematuria metabolism, Humans, Male, Middle Aged, Pain, Tomography, X-Ray Computed, Urinary Bladder Diseases diagnosis, Urinary Bladder Diseases metabolism, Amyloidosis complications, Hematuria etiology, Serum Amyloid A Protein metabolism, Urinary Bladder Diseases complications
Abstract

A 45-year-old diabetic man presented with an episodic history of painless gross hematuria. He had had no previous urinary symptoms or any other medical problems. His physical examination, urine cytology, and computed tomography scan findings were normal. Cystoscopy demonstrated two nodular masses in the urinary bladder with a hemorrhagic mucosal surface. Biopsies revealed amyloidosis, and immunohistochemical staining of the specimens defined the process as amyloid AA (mostly seen in secondary amyloidosis). The workup for systemic conditions associated with amyloid AA was negative. This represents an unusual case of primary localized AA-type amyloidosis of the bladder.

Published
2006
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