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1. Global Practice Patterns in the Evaluation of Non-Obstructive Azoospermia: Results of a World-Wide Survey and Expert Recommendations

Author

Rupin Shah, Amarnath Rambhatla, Widi Atmoko, Marlon Martinez, Imad Ziouziou, Priyank Kothari, Nicholas Tadros, Nguyen Ho Vinh Phuoc, Parviz Kavoussi, Ahmed Harraz, Gianmaria Salvio, Murat Gul, Taha Hamoda, Tuncay Toprak, Ponco Birowo, Edmund Ko, Mohamed Arafa, Ramy Abou Ghayda, Vilvapathy Senguttuvan Karthikeyan, Ramadan Saleh, Giorgio Ivan Russo, Germar-Michael Pinggera, Eric Chung, Missy Savira, Giovanni M. Colpi, Wael Zohdy, Edoardo Pescatori, Hyun Jun Park, Shinichiro Fukuhara, Akira Tsujimura, Cesar Rojas-Cruz, Angelo Marino, Siu King Mak, Edouard Amar, Wael Ibrahim, Puneet Sindhwani, Naif Alhathal, Gian Maria Busetto, Manaf Al Hashimi, Ahmed El-Sakka, Asci Ramazan, Fotios Dimitriadis, Massimiliano Timpano, Davor Jezek, Baris Altay, Daniel Suslik Zylbersztejn, Michael YC Wong, Du Geon Moon, Christine Wyns, Safar Gamidov, Hamed Akhavizadegan, Alessandro Franceschelli, Kaan Aydos, Vinh Nguyen Quang, Shedeed Ashour, Adel Al Dayel, Mohamed S. Al-Marhoon, Sava Micic, Saleh Binsaleh, Alayman Hussein, Haitham Elbardisi, Taymour Mostafa, Emad Taha, Jonathan Ramsay, Athanasios Zachariou, Islam Fathy Soliman Abdelrahman, Osvaldo Rajmil, Arif Kalkanli, Juan Manuel Corral Molina, Kadir Bocu, Gede Wirya Kusuma Duarsa, Gokhan Ceker, Ege Can Serefoglu, Fahmi Bahar, Nazim Gherabi, Shinnosuke Kuroda, Abderrazak Bouzouita, Ahmet Gudeloglu, Erman Ceyhan, Mohamed Saeed Mohamed Hasan, Muhammad Ujudud Musa, Ahmad Motawi, Cho Chak-Lam, Hisanori Taniguchi, Christopher Chee Kong Ho, Jesus Fernando Solorzano Vazquez, Shingai Mutambirwa, Nur Dokuzeylul Gungor, Marion Bendayan, Carlo Giulioni, Aykut Baser, Marco Falcone, Luca Boeri, Gideon Blecher, Alireza Kheradmand, Tamilselvi Sethupathy, Ricky Adriansjah, Nima Narimani, Charalampos Konstantinidis, Tuan Thanh Nguyen, Andrian Japari, Parisa Dolati, Keerti Singh, Cevahir Ozer, Selcuk Sarikaya, Nadia Sheibak, Ndagijimana Jean Bosco, Mehmet Serkan Özkent, Sang Thanh Le, Ioannis Sokolakis, Darren Katz, Ryan Smith, Manh Nguyen Truong, Tan V. Le, Zhongwei Huang, Muslim Dogan Deger, Umut Arslan, Gokhan Calik, Giorgio Franco, Ayman Rashed, Oguzhan Kahraman, Sotiris Andreadakis, Rosadi Putra, Giancarlo Balercia, Kareim Khalafalla, Rossella Cannarella, Anh Đặng Tuấn, Amr El Meliegy, Birute Zilaitiene, Marlene Lizbeth Zamora Ramirez, Filippo Giacone, Aldo E. Calogero, Konstantinos Makarounis, Sunil Jindal, Bac Nguyen Hoai, Ravi Banthia, Marcelo Rodriguez Peña, Dharani Moorthy, Aram Adamyan, Deniz Kulaksiz, Hussein Kandil, Nikolaos Sofikitis, Ciro Salzano, Andreas Jungwirth, Surendra Reddy Banka, Tiago Cesar Mierzwa, Tahsin Turunç, Divyanu Jain, Armen Avoyan, Pietro Salacone, Ateş Kadıoğlu, Chirag Gupta, Haocheng Lin, Iman Shamohammadi, Nasser Mogharabian, Trenton Barrett, Yavuz Onur Danacıoğlu, Andrea Crafa, Salima Daoud, Vineet Malhotra, Abdulmalik Almardawi, Osama Mohamed Selim, Mohamad Moussa, Saeid Haghdani, Mesut Berkan Duran, Yannic Kunz, Mirko Preto, Elena Eugeni, Thang Nguyen, Ahmed Rashad Elshahid, Seso Sulijaya Suyono, Dyandra Parikesit, Essam Nada, Eduardo Gutiérrez Orozco, Florence Boitrelle, Nguyen Thi Minh Trang, Mounir Jamali, Raju Nair, Mikhail Ruzaev, Franco Gadda, Charalampos Thomas, Raphael Henrique Ferreira, Umit Gul, Serena Maruccia, Ajay Kanbur, Ella Kinzikeeva, Saad Abumelha, Nguyen Quang, Raghavender Kosgi, Fatih Gokalp, Mohammad Ayodhia Soebadi, Gustavo Marquesine Paul, Hesamoddin Sajadi, Deepak Gupte, Rafael F. Ambar, Emrullah Sogutdelen, Karun Singla, Ari Basurkano, Shannon Hee Kyung Kim, Mohammad Ali Sadighi Gilani, Koichi Nagao, Sakti Ronggowardhana Brodjonegoro, Andri Rezano, Mohamed Elkhouly, Rossella Mazzilli, Hasan M. A. Farsi, Hung Nguyen Ba, Hamed Alali, Dimitrios Kafetzis, Tran Quang Tien Long, Sami Alsaid, Hoang Bao Ngoc Cuong, Knigavko Oleksandr, Akhmad Mustafa, Herik Acosta, Hrishikesh Pai, Bahadır Şahin, Eko Arianto, Colin Teo, Sanjay Prakash Jayaprakash, Rinaldo Indra Rachman, Mustafa Gurkan Yenice, Omar Sefrioui, Smit Paghdar, Shivam Priyadarshi, Marko Tanic, Noor Kareem Alfatlawy, Fikri Rizaldi, Ranjit B. Vishwakarma, George Kanakis, Dinesh Thomas Cherian, Joe Lee, Raisa Galstyan, Hakan Keskin, Jana Wurzacher, Doddy Hami Seno, Bambang S. Noegroho, Ria Margiana, Qaisar Javed, Fabrizio Castiglioni, Raman Tanwar, Ana Puigvert, Coşkun Kaya, Medianto Purnomo, Chadi Yazbeck, Azwar Amir, Edson Borges, Marina Bellavia, Isaac Ardianson Deswanto, Vinod K V, Giovanni Liguori, Dang Hoang Minh, Kashif Siddiqi, Fulvio Colombo, Armand Zini, Niket Patel, Selahittin Çayan, Ula Al-Kawaz, Maged Ragab, Guadalupe Hernández Hebrard, Ivan Hoffmann, Ozan Efesoy, Barış Saylam, and Ashok Agarwal

Subjects
azoospermia, diagnosis, guideline, infertility, male, surveys and questionnaires, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. Materials and Methods:Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 coun-tries were analyzed descriptively, with a Delphi process used for expert recommendations. Results:Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoosper-mia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differ-entiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. Conclusions:Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Published
2024
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2. Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Author

Ashok Agarwal, Ala’a Farkouh, Ramadan Saleh, Taha Abo-Almagd Abdel-Meguid Hamoda, Gianmaria Salvio, Florence Boitrelle, Ahmed M. Harraz, Ramy Abou Ghayda, Parviz Kavoussi, Murat Gül, Tuncay Toprak, Giorgio Ivan Russo, Damayanthi Durairajanayagam, Amarnath Rambhatla, Ponco Birowo, Rossella Cannarella, Nguyen Ho Vinh Phuoc, Armand Zini, Mohamed Arafa, Christine Wyns, Kelton Tremellen, Selçuk Sarıkaya, Sheena Lewis, Donald P. Evenson, Edmund Ko, Aldo E. Calogero, Fahmi Bahar, Marlon Martínez, Rafael F. Ambar, Giovanni M. Colpi, Mustafa Emre Bakircioglu, Ralf Henkel, Hussein Kandil, Ege Can Serefoglu, Abdullah Alfakhri, Akira Tsujimura, Alireza Kheradmand, 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, Nguyen Quang, Germar-Michael Pinggera, Priyank Kothari, Sava Micic, Sheryl Homa, Tran Quang Tien Long, Wael Zohdy, Widi Atmoko, Wael Ibrahim, Marjan Sabbaghian, Saad Mohammed Abumelha, Eric Chung, Muhammet Rasit Ugur, Mehmet Serkan Ozkent, Osama Selim, Mahsa Darbandi, Shinichiro Fukuhara, Mounir Jamali, Jean de la Rosette, Shinnosuke Kuroda, Ryan P. Smith, Aykut Baser, Arif Kalkanli, Nicholas N. Tadros, Kaan Aydos, Tiago Cesar Mierzwa, Kareim Khalafalla, Vineet Malhotra, Mohamad Moussa, Federica Finocchi, Rinaldo Indra Rachman, Carlo Giulioni, Tomer Avidor-Reiss, Oguzhan Kahraman, Gökhan Çeker, Cătălina Zenoaga-Barbăroșie, Trenton L. Barrett, Mehmet Yilmaz, Ates Kadioglu, Sunil Jindal, Huda Omran, Kadir Bocu, Vilvapathy Senguttuvan Karthikeyan, Giorgio Franco, Jesús Fernando Solorzano, Ranjit B. Vishwakarma, Eko Arianto, Nicolas Garrido, Divyanu Jain, Nazim Gherabi, Ioannis Sokolakis, Ayad Palani, Gokhan Calik, Deniz Kulaksiz, Vaida Simanaviciene, Mara Simopoulou, Nur Dokuzeylül Güngör, Gideon Blecher, Marco Falcone, Davor Jezek, Mirko Preto, Edouard Amar, Tan V. Le, Sun Tae Ahn, Andri Rezano, Keerti Singh, Lucia Rocco, Missy Savira, Osvaldo Rajmil, Sara Darbandi, Emrullah Sogutdelen, Luca Boeri, Guadalupe Hernández, Lukman Hakim, Yoshiharu Morimoto, Andrian Japari, Nikolaos Sofikitis, Baris Altay, Asli Metin Mahmutoglu, Manaf Al Hashimi, Imad Ziouziou, Christina Anagnostopoulou, Haocheng Lin, and Rupin Shah

Subjects
delphi method, diagnostic test, dna fragmentation, infertility, male, survey, Medicine, Diseases of the genitourinary system. Urology, RC870-923
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.

Published
2024
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3. 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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4. An update in improving erectile dysfunction therapy in Indonesia by using Li-ESWT and tadalafil combination — vascular endothelial growth factor and peak systolic velocity comparison: a randomized clinical trial

Author

Androniko Setiawan, Andrian Japari, Rosy Nur Febriani, Silvia Werdhy Lestari, Tjahjo Djojo Tanojo, Maria Paulina Budyandini Dyah Pramesti, Agustinus Agustinus, Mu-hammad Hidayat Surya Atmaja, Munawaroh Fitriah, and Budi Utomo

Subjects
erectile dysfunction, li-eswt, tadalafil, psv, vegf, Medicine (General), R5-920
Abstract

Background: Erectile dysfunction (ED) affects men’s life desperately and the incidence increases continuously. There are a few lines of ED therapy, but there are still many ED cases that have not treated utterly. Therefore, research is needed to obtain the most appropriate line of ED therapy, based on the underlying mechanism of ED. The aim of this study is to analyze the effect of oral daily 2.5 mg of tadalafil administration and twice weekly Low Intensity Extracorporeal Shockwave Therapy (Li-ESWT) for 4 weeks in erectile dysfunction patients, based on Peak Systolic Velocity (PSV) and Vascular Endothelial Growth Factor (VEGF). Methods: A 26-sample clinical trial was conducted with pre and post-test control group design. Random allocation was done to divide the samples into two groups. Control group was given 2.5 mg oral daily tadalafil, while the experimental group, additional twice weekly Li-ESWT was given. Therapies were given for 4 weeks. All subjects were assessed using Erection Hardness Score (EHS) score, International Index of Erectile Function (IIEF-5) score, and Color Doppler Ultrasonography (CDUS) penis for PSV, and plasma level of VEGF twice, prior to and after therapy. Results: The experimental group showed significant improvement compared to the control group in EHS (delta) 2 (1–2) vs 1 (0–2); IIEF-5 (delta) 7 (3–15) vs 4 (0–11); PSV (delta) 2.60 ± 1.34 vs 1.28 ± 1.86; and VEGF (delta) 26.69 ± 24.23 vs 6.32 ± 25.43. Conclusions: Li-ESWT and tadalafil combination therapy improved erectile dysfunction, specifically based on PSV and VEGF parameters.

Published
2022
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5. 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, 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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

6. An update in improving erectile dysfunction therapy in Indonesia by using Li-ESWT and tadalafil combination - vascular endothelial growth factor and peak systolic velocity comparison: a randomized clinical trial

Author

Budi Utomo, Munawaroh Fitriah, Mu-hammad Hidayat Surya Atmaja, Agustinus Agustinus, Maria Paulina Budyandini Dyah Pramesti, Tjahjo Djojo Tanojo, Silvia Werdhy Lestari, Rosy Nur Febriani, Andrian Japari, and Androniko Setiawan

Subjects
Urology, General Medicine
Published
2022
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