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

Author

Farkouh, Ala’a, Agarwal, Ashok, Hamoda, Taha Abo-Almagd Abdel-Meguid, Kavoussi, Parviz, Saleh, Ramadan, Zini, Armand, Arafa, Mohamed, Harraz, Ahmed M., Gul, Murat, Karthikeyan, Vilvapathy Senguttuvan, Durairajanayagam, Damayanthi, Rambhatla, Amarnath, Boitrelle, Florence, Chung, Eric, Birowo, Ponco, Toprak, Tuncay, Ghayda, Ramy Abou, Cannarella, Rossella, Phuoc, Nguyen Ho Vinh, Dimitriadis, Fotios, Russo, Giorgio I., Sokolakis, Ioannis, Mostafa, Taymour, Makarounis, Konstantinos, Ziouziou, Imad, Kuroda, Shinnosuke, Bendayan, Marion, Kaiyal, Raneen Sawaid, Japari, Andrian, Simopoulou, Mara, Rocco, Lucia, Garrido, Nicolas, Gherabi, Nazim, Bocu, Kadir, Kahraman, Oguzhan, Le, Tan V., Wyns, Christine, Tremellen, Kelton, Sarikaya, Selcuk, Lewis, Sheena, Evenson, Donald P., Ko, Edmund, Calogero, Aldo E., Bahar, Fahmi, Martinez, Marlon, Crafa, Andrea, Nguyen, Quang, Ambar, Rafael F., Colpi, Giovanni, Bakircioglu, Mustafa Emre, Henkel, Ralf, Kandil, Hussein, Serefoglu, Ege Can, Alarbid, Abdullah, Tsujimura, Akira, Kheradmand, Alireza, Anagnostopoulou, Christina, Marino, Angelo, Adamyan, Aram, Zilaitiene, Birute, Ozer, Cevahir, Pescatori, Edoardo, Vogiatzi, Paraskevi, Busetto, Gian Maria, Balercia, Giancarlo, Elbardisi, Haitham, Akhavizadegan, Hamed, Sajadi, Hesamoddin, Taniguchi, Hisanori, Park, Hyun Jun, Rosas, Israel Maldonado, Al-Marhoon, Mohamed, Gilani, Mohammad Ali Sadighi, Alhathal, Naif, Pinggera, Germar-Michael, Kothari, Priyank, Mogharabian, Nasser, Micic, Sava, Homa, Sheryl T., Darbandi, Sara, Long, Tran Quang Tien, Zohdy, Wael, Atmoko, Widi, Sabbaghian, Marjan, Ibrahim, Wael, Smith, Ryan P., Ho, Christopher Chee Kong, Rosette, Jean de la, El-Sakka, Ahmed I., Preto, Mirko, Zenoaga-Barbăroșie, Cătălina, Abumelha, Saad Mohammed, Baser, Aykut, Aydos, Kaan, Ramirez-Dominguez, Liliana, Kumar, Vijay, Ong, Teng Aik, Mierzwa, Tiago Cesar, Adriansjah, Ricky, Banihani, Saleem A., Bowa, Kasonde, Fukuhara, Shinichiro, Peña, Marcelo Rodriguez, Moussa, Mohamad, Ari, Umut Çağın, Cho, Chak-Lam, Tadros, Nicholas N., Ugur, Muhammet Rasit, Amar, Edouard, Falcone, Marco, Santer, Frederic Romain, Kalkanli, Arif, Karna, Keshab Kumar, Khalafalla, Kareim, Vishwakarma, Ranjit B., Finocchi, Federica, Giulioni, Carlo, Ceyhan, Erman, Çeker, Gökhan, Yazbeck, Chadi, Rajmil, Osvaldo, Yilmaz, Mehmet, Altay, Baris, Barrett, Trenton L., Ngoo, Kay Seong, Roychoudhury, Shubhadeep, Salvio, Gianmaria, Lin, Haocheng, Kadioglu, Ates, Timpano, Massimiliano, Avidor-Reiss, Tomer, Hakim, Lukman, Sindhwani, Puneet, Franco, Giorgio, Singh, Rajender, Giacone, Filippo, Ruzaev, Mikhail, Kosgi, Raghavender, Sofikitis, Nikolaos, Palani, Ayad, Calik, Gokhan, Kulaksız, Deniz, Jezek, Davor, Al Hashmi, Manaf, Drakopoulos, Panagiotis, Omran, Huda, Leonardi, Sofia, Celik-Ozenci, Ciler, Güngör, Nur Dokuzeylül, Ramsay, Jonathan, Amano, Toshiyasu, Sogutdelen, Emrullah, Duarsa, Gede Wirya Kusuma, Chiba, Koji, Jindal, Sunil, Savira, Missy, Boeri, Luca, Borges, Edson, Gupte, Deepak, Gokalp, Fatih, Hebrard, Guadalupe Hernández, Minhas, Suks, Shah, Rupin, Farkouh, Ala’a, Agarwal, Ashok, Hamoda, Taha Abo-Almagd Abdel-Meguid, Kavoussi, Parviz, Saleh, Ramadan, Zini, Armand, Arafa, Mohamed, Harraz, Ahmed M., Gul, Murat, Karthikeyan, Vilvapathy Senguttuvan, Durairajanayagam, Damayanthi, Rambhatla, Amarnath, Boitrelle, Florence, Chung, Eric, Birowo, Ponco, Toprak, Tuncay, Ghayda, Ramy Abou, Cannarella, Rossella, Phuoc, Nguyen Ho Vinh, Dimitriadis, Fotios, Russo, Giorgio I., Sokolakis, Ioannis, Mostafa, Taymour, Makarounis, Konstantinos, Ziouziou, Imad, Kuroda, Shinnosuke, Bendayan, Marion, Kaiyal, Raneen Sawaid, Japari, Andrian, Simopoulou, Mara, Rocco, Lucia, Garrido, Nicolas, Gherabi, Nazim, Bocu, Kadir, Kahraman, Oguzhan, Le, Tan V., Wyns, Christine, Tremellen, Kelton, Sarikaya, Selcuk, Lewis, Sheena, Evenson, Donald P., Ko, Edmund, Calogero, Aldo E., Bahar, Fahmi, Martinez, Marlon, Crafa, Andrea, Nguyen, Quang, Ambar, Rafael F., Colpi, Giovanni, Bakircioglu, Mustafa Emre, Henkel, Ralf, Kandil, Hussein, Serefoglu, Ege Can, Alarbid, Abdullah, Tsujimura, Akira, Kheradmand, Alireza, Anagnostopoulou, Christina, Marino, Angelo, Adamyan, Aram, Zilaitiene, Birute, Ozer, Cevahir, Pescatori, Edoardo, Vogiatzi, Paraskevi, Busetto, Gian Maria, Balercia, Giancarlo, Elbardisi, Haitham, Akhavizadegan, Hamed, Sajadi, Hesamoddin, Taniguchi, Hisanori, Park, Hyun Jun, Rosas, Israel Maldonado, Al-Marhoon, Mohamed, Gilani, Mohammad Ali Sadighi, Alhathal, Naif, Pinggera, Germar-Michael, Kothari, Priyank, Mogharabian, Nasser, Micic, Sava, Homa, Sheryl T., Darbandi, Sara, Long, Tran Quang Tien, Zohdy, Wael, Atmoko, Widi, Sabbaghian, Marjan, Ibrahim, Wael, Smith, Ryan P., Ho, Christopher Chee Kong, Rosette, Jean de la, El-Sakka, Ahmed I., Preto, Mirko, Zenoaga-Barbăroșie, Cătălina, Abumelha, Saad Mohammed, Baser, Aykut, Aydos, Kaan, Ramirez-Dominguez, Liliana, Kumar, Vijay, Ong, Teng Aik, Mierzwa, Tiago Cesar, Adriansjah, Ricky, Banihani, Saleem A., Bowa, Kasonde, Fukuhara, Shinichiro, Peña, Marcelo Rodriguez, Moussa, Mohamad, Ari, Umut Çağın, Cho, Chak-Lam, Tadros, Nicholas N., Ugur, Muhammet Rasit, Amar, Edouard, Falcone, Marco, Santer, Frederic Romain, Kalkanli, Arif, Karna, Keshab Kumar, Khalafalla, Kareim, Vishwakarma, Ranjit B., Finocchi, Federica, Giulioni, Carlo, Ceyhan, Erman, Çeker, Gökhan, Yazbeck, Chadi, Rajmil, Osvaldo, Yilmaz, Mehmet, Altay, Baris, Barrett, Trenton L., Ngoo, Kay Seong, Roychoudhury, Shubhadeep, Salvio, Gianmaria, Lin, Haocheng, Kadioglu, Ates, Timpano, Massimiliano, Avidor-Reiss, Tomer, Hakim, Lukman, Sindhwani, Puneet, Franco, Giorgio, Singh, Rajender, Giacone, Filippo, Ruzaev, Mikhail, Kosgi, Raghavender, Sofikitis, Nikolaos, Palani, Ayad, Calik, Gokhan, Kulaksız, Deniz, Jezek, Davor, Al Hashmi, Manaf, Drakopoulos, Panagiotis, Omran, Huda, Leonardi, Sofia, Celik-Ozenci, Ciler, Güngör, Nur Dokuzeylül, Ramsay, Jonathan, Amano, Toshiyasu, Sogutdelen, Emrullah, Duarsa, Gede Wirya Kusuma, Chiba, Koji, Jindal, Sunil, Savira, Missy, Boeri, Luca, Borges, Edson, Gupte, Deepak, Gokalp, Fatih, Hebrard, Guadalupe Hernández, Minhas, Suks, and Shah, Rupin

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 elevat

Published
2023

2. 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, 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, Ioannis, 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 T., Karthikeyan, Vilvapathy Senguttuvan, Zilaitiene, Birute, Rosas, Israel Maldonado, Marino, Angelo, Pescatori, Edoardo, Ozer, Cevahir, Akhavizadegan, Hamed, Garrido, Nicolas, 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-Barbăroşie, 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, Sotiris, 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, Ates, Gadda, Franco, Zylbersztejn, Daniel Suslik, Aydos, Kaan, Kulaksız, Deniz, Gupte, Deepak, Calik, Gokhan, Karna, Keshab Kumar, Drakopoulos, Panagiotis, 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, 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, Ioannis, 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 T., Karthikeyan, Vilvapathy Senguttuvan, Zilaitiene, Birute, Rosas, Israel Maldonado, Marino, Angelo, Pescatori, Edoardo, Ozer, Cevahir, Akhavizadegan, Hamed, Garrido, Nicolas, 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-Barbăroşie, 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, Sotiris, 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, Ates, Gadda, Franco, Zylbersztejn, Daniel Suslik, Aydos, Kaan, Kulaksız, Deniz, Gupte, Deepak, Calik, Gokhan, Karna, Keshab Kumar, Drakopoulos, Panagiotis, 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, and Shah, Rupin

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

Published
2023

3. 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

4. Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations.

Author

Rambhatla A, Shah R, Ziouziou I, Kothari P, Salvio G, Gul M, Hamoda T, Kavoussi P, Atmoko W, Toprak T, Birowo P, Ko E, Arafa M, Ghayda RA, Karthikeyan VS, Russo GI, Pinggera GM, Chung E, Harraz AM, Martinez M, Phuoc NHV, Tadros N, Saleh R, Savira M, Colpi GM, Zohdy W, Pescatori E, Park HJ, Fukuhara S, Tsujimura A, Rojas-Cruz C, Marino A, Mak SK, Amar E, Ibrahim W, Sindhwani P, Alhathal N, Busetto GM, Al Hashimi M, El-Sakka A, Ramazan A, Dimitriadis F, Timpano M, Jezek D, Altay B, Zylbersztejn DS, Wong MY, Moon DG, Wyns C, Gamidov S, Akhavizadegan H, Franceschelli A, Aydos K, Quang N, Ashour S, Al Dayel A, Al-Marhoon MS, Micic S, Binsaleh S, Hussein A, Elbardisi H, Mostafa T, Ramsay J, Zachariou A, Abdelrahman IFS, Rajmil O, Kalkanli A, Molina JMC, Bocu K, Duarsa GWK, Çeker G, Serefoglu EC, Bahar F, Gherabi N, Kuroda S, Bouzouita A, Gudeloglu A, Ceyhan E, Hasan MSM, Musa MU, Motawi A, Cho CL, Taniguchi H, Ho CCK, Vazquez JFS, Mutambirwa S, Gungor ND, Bendayan M, Giulioni C, Baser A, Falcone M, Boeri L, Blecher G, Kheradmand A, Sethupathy T, Adriansjah R, Narimani N, Konstantinidis C, Nguyen TT, Japari A, Dolati P, Singh K, Ozer C, Sarikaya S, Sheibak N, Bosco NJ, Özkent MS, Le ST, Sokolakis I, Katz D, Smith R, Truong MN, Le TV, Huang Z, Deger MD, Arslan U, Calik G, Franco G, Rashed A, Kahraman O, Andreadakis S, Putra R, Balercia G, Khalafalla K, Cannarella R, Tuấn AĐ, El Meliegy A, Zilaitiene B, Ramirez MLZ, Giacone F, Calogero AE, Makarounis K, Jindal S, Hoai BN, Banthia R, Peña MR, Moorthy D, Adamyan A, Kulaksiz D, Kandil H, Sofikitis N, Salzano C, Jungwirth A, Banka SR, Mierzwa TC, Turunç T, Jain D, Avoyan A, Salacone P, Kadıoğlu A, Gupta C, Lin H, Shamohammadi I, Mogharabian N, Barrett T, Danacıoğlu YO, Crafa A, Daoud S, Malhotra V, Almardawi A, Selim OM, Moussa M, Haghdani S, Duran MB, Kunz Y, Preto M, Eugeni E, Nguyen T, Elshahid AR, Suyono SS, Parikesit D, Nada E, Orozco EG, Boitrelle F, Trang NTM, Jamali M, Nair R, Ruzaev M, Gadda F, Thomas C, Ferreira RH, Gul U, Maruccia S, Kanbur A, Kinzikeeva E, Abumelha SM, Kosgi R, Gokalp F, Soebadi MA, Paul GM, Sajadi H, Gupte D, Ambar RF, Sogutdelen E, Singla K, Basukarno A, Kim SHK, Gilani MAS, Nagao K, Brodjonegoro SR, Rezano A, Elkhouly M, Mazzilli R, Farsi HMA, Ba HN, Alali H, Kafetzis D, Long TQT, Alsaid S, Cuong HBN, Oleksandr K, Mustafa A, Acosta H, Pai H, Şahin B, Arianto E, Teo C, Jayaprakash SP, Rachman RI, Yenice MG, Sefrioui O, Priyadarshi S, Tanic M, Alfatlaw NK, Rizaldi F, Vishwakarma RB, Kanakis G, Cherian DT, Lee J, Galstyan R, Keskin H, Wurzacher J, Seno DH, Noegroho BS, Margiana R, Javed Q, Castiglioni F, Tanwar R, Puigvert A, Kaya C, Purnomo M, Yazbeck C, Amir A, Borges E, Bellavia M, Deswanto IA, Kv V, Liguori G, Minh DH, Siddiqi K, Colombo F, Zini A, Patel N, Çayan S, Al-Kawaz U, Ragab M, Hebrard GH, de la Rosette J, Efesoy O, Hoffmann I, Teixeira TA, Saylam B, Delgadillo D, and Agarwal A

Abstract

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA., Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process., Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit., Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines., Competing Interests: The authors have nothing to disclose., (Copyright © 2025 Korean Society for Sexual Medicine and Andrology.)

Published
2025
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5. 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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6. 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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7. 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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