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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

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, Mara Simopoulou, Lucia Rocco, Nicolas Garrido, Nazim Gherabi, Kadir Bocu, Oguzhan Kahraman, Tan V. Le, Christine Wyns, Kelton Tremellen, Selcuk Sarikaya, Sheena Lewis, Donald P. Evenson, Edmund Ko, Aldo E. Calogero, Fahmi Bahar, Marlon Martinez, Andrea Crafa, Quang Nguyen, Rafael F. Ambar, Giovanni Colpi, Mustafa Emre Bakircioglu, Ralf Henkel, Hussein Kandil, Ege Can Serefoglu, Abdullah Alarbid, Akira Tsujimura, Alireza Kheradmand, Christina Anagnostopoulou, Angelo Marino, Aram Adamyan, Birute Zilaitiene, Cevahir Ozer, Edoardo Pescatori, Paraskevi Vogiatzi, Gian Maria Busetto, Giancarlo Balercia, Haitham Elbardisi, Hamed Akhavizadegan, Hesamoddin Sajadi, Hisanori Taniguchi, Hyun Jun Park, Israel Maldonado Rosas, Mohamed Al-Marhoon, Mohammad Ali Sadighi Gilani, Naif Alhathal, Germar-Michael Pinggera, Priyank Kothari, Nasser Mogharabian, Sava Micic, Sheryl Homa, Sara Darbandi, Tran Quang Tien Long, Wael Zohdy, Widi Atmoko, Marjan Sabbaghian, Wael Ibrahim, Ryan P. Smith, Christopher Chee Kong Ho, Jean de la Rosette, Ahmed I. El-Sakka, Mirko Preto, Cătălina Zenoaga-Barbăroșie, Saad Mohammed Abumelha, Aykut Baser, Kaan Aydos, Liliana Ramirez-Dominguez, Vijay Kumar, Teng Aik Ong, Tiago Cesar Mierzwa, Ricky Adriansjah, Saleem A. Banihani, Kasonde Bowa, Shinichiro Fukuhara, Marcelo Rodriguez Peña, Mohamad Moussa, Umut Çağın Ari, Chak-Lam Cho, Nicholas N. Tadros, Muhammet Rasit Ugur, Edouard Amar, Marco Falcone, Frederic Romain Santer, Arif Kalkanli, Keshab Kumar Karna, Kareim Khalafalla, Ranjit B. Vishwakarma, Federica Finocchi, Carlo Giulioni, Erman Ceyhan, Gökhan Çeker, Chadi Yazbeck, Osvaldo Rajmil, Mehmet Yilmaz, Baris Altay, Trenton L. Barrett, Kay Seong Ngoo, Shubhadeep Roychoudhury, Gianmaria Salvio, Haocheng Lin, Ates Kadioglu, Massimiliano Timpano, Tomer Avidor-Reiss, Lukman Hakim, Puneet Sindhwani, Giorgio Franco, Rajender Singh, Filippo Giacone, Mikhail Ruzaev, Raghavender Kosgi, Nikolaos Sofikitis, Ayad Palani, Gokhan Calik, Deniz Kulaksız, Davor Jezek, Manaf Al Hashmi, Panagiotis Drakopoulos, Huda Omran, Sofia Leonardi, Ciler Celik-Ozenci, Nur Dokuzeylül Güngör, Jonathan Ramsay, Toshiyasu Amano, Emrullah Sogutdelen, Gede Wirya Kusuma Duarsa, Koji Chiba, Sunil Jindal, Missy Savira, Luca Boeri, Edson Borges, Deepak Gupte, Fatih Gokalp, Guadalupe Hernández Hebrard, Suks Minhas, and Rupin Shah

Subjects
delphi method, disease management, dna fragmentation, male infertility, practice guideline, survey, Medicine, Diseases of the genitourinary system. Urology, RC870-923
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
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2. Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis

Author

Rossella Cannarella, Ramadan Saleh, Florence Boitrelle, Murat Gül, Tuncay Toprak, Gianmaria Salvio, Mohamed Arafa, Giorgio I. Russo, Ahmed M. Harraz, Rajender Singh, Nicolas Garrido, Taha Abo-Almagd Abdel-Meguid Hamoda, Amarnath Rambhatla, Parviz Kavoussi, Shinnosuke Kuroda, Gökhan Çalik, Pallavi Saini, Erman Ceyhan, Fotios Dimitriadis, Ralf Henkel, Andrea Crafa, Ayad Palani, Mesut Berkan Duran, Evangelos Maziotis, Émine Saïs, Marion Bendayan, Mahsa Darbandi, Tan V. Le, Sezgin Gunes, Petroula Tsioulou, Pallav Sengupta, Berk Hazir, Gökhan Çeker, Sara Darbandi, Damayanthi Durairajanayagam, Azin Aghamajidi, Noora Alkhalidi, Emrullah Sogutdelen, Kristian Leisegang, Abdullah Alarbid, Christopher C. K. Ho, Vineet Malhotra, Federica Finocchi, Luís Crisóstomo, Raghavender Kosgi, Haitham ElBardisi, Armand Zini, Ponco Birowo, Giovanni Colpi, Hyun Jun Park, Ege Can Serefoglu, Quang Nguyen, Edmund Ko, Jean de la Rosette, Germar M. Pinggera, Ho Vinh Phuoc Nguyen, Hussein Kandil, and Rupin Shah

Subjects
male infertility, semen, varicocele, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls. Materials and Methods: A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies). Results: A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p

Published
2023
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3. Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

Author

Rupin Shah, Ashok Agarwal, Parviz Kavoussi, Amarnath Rambhatla, Ramadan Saleh, Rossella Cannarella, Ahmed M. Harraz, Florence Boitrelle, Shinnosuke Kuroda, Taha Abo-Almagd Abdel-Meguid Hamoda, Armand Zini, Edmund Ko, Gokhan Calik, Tuncay Toprak, Hussein Kandil, Murat Gül, Mustafa Emre Bakırcıoğlu, Neel Parekh, Giorgio Ivan Russo, Nicholas Tadros, Ates Kadioglu, Mohamed Arafa, Eric Chung, Osvaldo Rajmil, Fotios Dimitriadis, Vineet Malhotra, Gianmaria Salvio, Ralf Henkel, Tan V. Le, Emrullah Sogutdelen, Sarah Vij, Abdullah Alarbid, Ahmet Gudeloglu, Akira Tsujimura, Aldo E. Calogero, Amr El Meliegy, Andrea Crafa, Arif Kalkanli, Aykut Baser, Berk Hazir, Carlo Giulioni, Chak-Lam Cho, Christopher C.K. Ho, Ciro Salzano, Daniel Suslik Zylbersztejn, Dung Mai Ba Tien, Edoardo Pescatori, Edson Borges, Ege Can Serefoglu, Emine Saïs-Hamza, Eric Huyghe, Erman Ceyhan, Ettore Caroppo, Fabrizio Castiglioni, Fahmi Bahar, Fatih Gokalp, Francesco Lombardo, Franco Gadda, Gede Wirya Kusuma Duarsa, Germar-Michael Pinggera, Gian Maria Busetto, Giancarlo Balercia, Gianmartin Cito, Gideon Blecher, Giorgio Franco, Giovanni Liguori, Haitham Elbardisi, Hakan Keskin, Haocheng Lin, Hisanori Taniguchi, Hyun Jun Park, Imad Ziouziou, Jean de la Rosette, Jim Hotaling, Jonathan Ramsay, Juan Manuel Corral Molina, Ka Lun Lo, Kadir Bocu, Kareim Khalafalla, Kasonde Bowa, Keisuke Okada, Koichi Nagao, Koji Chiba, Lukman Hakim, Konstantinos Makarounis, Marah Hehemann, Marcelo Rodriguez Peña, Marco Falcone, Marion Bendayan, Marlon Martinez, Massimiliano Timpano, Mesut Altan, Mikkel Fode, Mohamed S. Al-Marhoon, Mohammad Ali Sadighi Gilani, Mohammad Ayodhia Soebadi, Nazim Gherabi, Nikolaos Sofikitis, Oğuzhan Kahraman, Ponco Birowo, Priyank Kothari, Puneet Sindhwani, Qaisar Javed, Rafael F. Ambar, Raghavender Kosgi, Ramy Abou Ghayda, Ricky Adriansjah, Rosita Angela Condorelli, Sandro La Vignera, Sava Micic, Shannon Hee Kyung Kim, Shinichiro Fukuhara, Sun Tae Ahn, Taymour Mostafa, Teng Aik Ong, Teppei Takeshima, Toshiyasu Amano, Trenton Barrett, Umut Arslan, Vilvapathy Senguttuvan Karthikeyan, Widi Atmoko, Yasushi Yumura, Yiming Yuan, Yuki Kato, Davor Jezek, Bryan Kwun-Chung Cheng, Georgios Hatzichristodoulou, Jun Dy, Eduard Ruiz Castañé, Ahmed I. El-Sakka, Quang Nguyen, Selcuk Sarikaya, Luca Boeri, Ronny Tan, Mohamad A. Moussa, Ahmed El-Assmy, Hamed Alali, Naif Alhathal, Yasser Osman, Dragoljub Perovic, Hesamoddin Sajadi, Hamed Akhavizadegan, Miroslav Vučinić, Said Kattan, Mohamed S. Kattan, Nasser Mogharabian, Nguyen Ho Vinh Phuoc, Kay Seong Ngoo, Mohammad H. Alkandari, Shaheed Alsuhaibani, Ioannis Sokolakis, Mehdi Babaei, Mak Siu King, Thorsten Diemer, Marcelo M. Gava, Raphael Henrique, Rodrigo Spinola e Silva, Gustavo Marquesine Paul, Tiago Cesar Mierzwa, Sidney Glina, Kashif Siddiqi, Han Wu, Jana Wurzacher, Ala’a Farkouh, Hwancheol Son, Suks Minhas, Joe Lee, Nikko Magsanoc, Paolo Capogrosso, German Jose Albano, Sheena E. M. Lewis, Channa N. Jayasena, Juan G. Alvarez, Colin Teo, Ryan P. Smith, Jo Ben M. Chua, Christian Fuglesang S. Jensen, Sijo Parekattil, Renata Finelli, Damayanthi Durairajanayagam, Keshab Kumar Karna, Abdelkareem Ahmed, Don Evenson, Yukihiro Umemoto, Ana Puigvert, Gökhan Çeker, and Giovanni M Colpi

Subjects
consensus, disease management, male infertility, survey, varicocele, Medicine, Diseases of the genitourinary system. Urology, RC870-923
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 Association [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 responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Published
2023
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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 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

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