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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. Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

Author

Rossella Cannarella, Rupin Shah, Taha Abo-Almagd Abdel-Meguid Hamoda, Florence Boitrelle, Ramadan Saleh, Murat Gul, Amarnath Rambhatla, Parviz Kavoussi, Tuncay Toprak, Ahmed M. Harraz, Edmund Ko, Gökhan Çeker, Damayanthi Durairajanayagam, Noora Alkahidi, Shinnosuke Kuroda, Andrea Crafa, Ralf Henkel, Gianmaria Salvio, Berk Hazir, Mahsa Darbandi, Marion Bendayan, Sara Darbandi, Marco Falcone, Raghavender Kosgi, Raneen Sawaid Kaiyal, Keshab Karna, Nguyen Ho Vinh Phuoc, Ponco Birowo, Giovanni M. Colpi, Jean de la Rosette, Germar-Michael Pinggera, Quang Nguyen, Armand Zini, Wael Zohdy, Rajender Singh, Pallavi Saini, Sidney Glina, Haocheng Lin, Taymour Mostafa, Cesar Rojas-Cruz, Mohamed Arafa, Aldo E. Calogero, Fotios Dimitriadis, Priyank Kothari, Vilvapathy Senguttuvan Karthikeyan, Keisuke Okada, Koji Chiba, Ates Kadıoglu, Baris Altay, Tahsin Turunc, Birute Zilaitiene, Fatih Gokalp, Aram Adamyan, Darren Katz, Eric Chung, Tiago Cesar Mierzwa, Daniel Suslik Zylbersztejn, Gustavo Marquesine Paul, Nikolaos Sofikitis, Ioannis Sokolakis, Vineet Malhotra, Sakti Ronggowardhana Brodjonegoro, Ricky Adriansjah, Akira Tsujimura, Toshiyasu Amano, Giancarlo Balercia, Imad Ziouziou, Isaac Ardianson Deswanto, Marlon Martinez, Hyun Jun Park, Mustafa Emre Bakırcıoglu, Erman Ceyhan, Kaan Aydos, Jonathan Ramsay, Suks Minhas, Manaf Al Hashimi, Ramy Abou Ghayda, Nicholas Tadros, Puneet Sindhwani, Christopher C.K. Ho, Rinaldo Indra Rachman, Marcelo Rodriguez Pena, Ahmad Motawi, Arun Karthik Ponnusamy, Satish Dipankar, Azwar Amir, Saleh Binsaleh, Ege Can Serefoglu, Ravi Banthia, Kareim Khalafalla, Ari Basukarno, Nguyen Hoai Bac, Karun Singla, Rafael F. Ambar, Konstantinos Makarounis, Shivam Priyadarshi, Gede Wirya Kusuma Duarsa, Widi Atmoko, Sunil Jindal, Eko Arianto, Hamed Akhavizadegan, Haitham El Bardisi, Ohad Shoshany, Gian Maria Busetto, Mohamad Moussa, Mounir Jamali, Mohamed S. Al-Marhoon, Mikhail Ruzaev, Hasan M. A. Farsi, Shingai Mutambirwa, Dong Sup Lee, Deniz Kulaksiz, Yu-Sheng Cheng, Abderrazak Bouzouita, Selcuk Sarikaya, Hussein Kandil, Georgios Tsampoukas, Ala’a Farkouh, Kasonde Bowa, Missy Savira, Nasser Mogharabian, Tan V. Le, Maruto Harjanggi, Dang Tuan Anh, Tran Quang Tien Long, Mohammad Ayodhia Soebadi, Lukman Hakim, Marko Tanic, Umut Cagin Ari, Firuza R. Parikh, Gokhan Calik, Vinod KV, Gyem Dorji, Andri Rezano, Osvaldo Rajmil, Dung Mai Ba Tien, Yiming Yuan, Juan Francisco Lizarraga-Salas, Balantine Eze, Kay Seong Ngoo, Joe Lee, Umut Arslan, and Ashok Agarwal

Subjects
controlled before-after studies, infertility, male, meta-analysis, varicocele, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Purpose: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles. Materials and Methods: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intraperson before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies). Results: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129–0.278; p

Published
2024
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3. 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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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, 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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5. Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Author

Ashok Agarwal, Neel Parekh, Manesh Kumar Panner Selvam, Ralf Henkel, Rupin Shah, Sheryl T. Homa, Ranjith Ramasamy, Edmund Ko, Kelton Tremellen, Sandro Esteves, Ahmad Majzoub, Juan G. Alvarez, David K. Gardner, Channa N. Jayasena, Jonathan W. Ramsay, Chak-Lam Cho, Ramadan Saleh, Denny Sakkas, James M. Hotaling, Scott D. Lundy, Sarah Vij, Joel Marmar, Jaime Gosalvez, Edmund Sabanegh, Hyun Jun Park, Armand Zini, Parviz Kavoussi, Sava Micic, Ryan Smith, Gian Maria Busetto, Mustafa Emre Bakırcıoğlu, Gerhard Haidl, Giancarlo Balercia, Nicolás Garrido Puchalt, Moncef Ben-Khalifa, Nicholas Tadros, Jackson Kirkman-Browne, Sergey Moskovtsev, Xuefeng Huang, Edson Borges Jr, Daniel Franken, Natan Bar-Chama, Yoshiharu Morimoto, Kazuhisa Tomita, Vasan Satya Srini, Willem Ombelet, Elisabetta Baldi, Monica Muratori, Yasushi Yumura, Sandro La Vignera, Raghavender Kosgi, Marlon P. Martinez, Donald P. Evenson, Daniel Suslik Zylbersztejn, Matheus Roque, Marcello Cocuzza, Marcelo Vieira, Assaf Ben-Meir, Raoul Orvieto, Eliahu Levitas, Amir Wiser, Mohamed Arafa, Vineet Malhotra, Sijo Joseph Parekattil, Haitham Elbardisi, Luiz Carvalho, Rima Dada, Christophe Sifer, Pankaj Talwar, Ahmet Gudeloglu, Ahmed M.A. Mahmoud, Khaled Terras, Chadi Yazbeck, Bojanic Nebojsa, Damayanthi Durairajanayagam, Ajina Mounir, Linda G. Kahn, Saradha Baskaran, Rishma Dhillon Pai, Donatella Paoli, Kristian Leisegang, Mohamed-Reza Moein, Sonia Malik, Onder Yaman, Luna Samanta, Fouad Bayane, Sunil K. Jindal, Muammer Kendirci, Baris Altay, Dragoljub Perovic, and Avi Harlev

Subjects
Infertility, male, MOSI, Oxidation reduction potential, Oxidative stress, Semen, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm’s potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

Published
2019
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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

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

8. The effect of percutaneous nephrostomy implementation on the outcome of ureteroscopic stone treatment

Author

Fuat, Kizilay, Adnan, Simsir, Baris, Altay, Oktay, Nazli, Ibrahim, Cureklibatir, and Bulent, Semerci

Subjects
Adult, Male, Kidney Calculi, Young Adult, Treatment Outcome, Adolescent, Ureteroscopy, Humans, Female, Middle Aged, Nephrostomy, Percutaneous, Retrospective Studies
Abstract

We aimed to investigate the effect of percutaneous nephrostomy (PCN) implementation on the second ureteroscopy (URS) outcomes after a failed URS.The data of four hundred forty-eight patients with an unsuccessful URS history were evaluated. Patients were divided into two groups; patients who underwent PCN before second URS (Group A) and patients who did not (Group B). We compared the stone access rate in the second URS between the two groups according to patient and stone characteristics and operative data. Then, group A was subdivided into two groups according to stone access as; access succeeded (Group A1) and access failed (Group A2). We also compared stone access rates between these two groups in terms of gender, age, body mass index, stone size, side, location, grade of hydronephrosis and PCN duration. All data were available immediately after surgery and obtained from patient files and the outcome assessment was performed during the study period.Stone access rate was higher in group A than group B (143/196 vs 41/252, P = .0018). Mean nephrostomy duration and mean hydronephrosis grade were significantly higher and mean stone size was significantly lower in group A1 than group A2 (18.74 vs 9.62 days, P.001; grade 3.25 vs 1.21, P = .038; and 7.286 vs 12.631 mm P.001, respectively).PCN is a favourable intervention after a failed URS and increases the success rate of the second operation with ease of implementation and minimal morbidity.

Published
2018

9. Consequences of epididymal ligation on prepubertal rats

Author

Hüseyin, Aktug, Kaan, Ozdedeli, Baris, Altay, Ibrahim, Cüreklibatur, Burak, Turna, and Ozlem, Yilmaz

Subjects
Epididymis, Male, Disease Models, Animal, Testis, Animals, Constriction, Pathologic, Genital Diseases, Male, Rats, Wistar, Immunohistochemistry, Ligation, Rats
Abstract

To study prospectively experimental effects of unilateral epididymal obstruction on testis and epididymis histopathologically in prepubertal rats.Organ weights, mean seminiferous tubule diameter (MSTD), mean ductus epididymis diameter (MDED), mean tubular biopsy scores (MTBS) and histopathology of 21 male albino Wistar rats were compared with the immunostaining affinity of anti-desmin, anti-vimentin, anti-laminin and anti-collagen antibodies.Statistical analysis of mean weight of testes, MTBS, mean epididymal weight, MDED and MSTD was significant. Evaluation of testis and epididymis revealed cellular damage, basal membrane impairment and granulomatous infiltration.Histopathologic alterations with MSTD are early indicators for ipsilateral and contralateral injury. Even the presence of criteria such as intactness and cellular integrity does not guarantee there is no sperm leakage or immunologic damage. Therefore the impairment of basal integrity is a switch code in determining spermatogenic failure.

Published
2007

10. Comparative Results of Shockwave Lithotripsy for Renal Calculi in Upper, Middle, and Lower Calices.

Author

Burak Turna, Fatih Ekren, Oktay Nazli, Kaan Akbay, Baris Altay, Ceyhun Ozyurt, and Necmettin Cikili

Subjects
LITHOTRIPSY, KIDNEY stones, SURGERY, CALCULI
Abstract

Background and Purpose To assess the results of shockwave lithotripsy (SWL) for renal calculi in upper, middle, and lower calices according to the stone burden.Patient and Methods A series of 52 female and 66 male patients with a mean age of 47.8 years and isolated single caliceal stones who underwent SWL monotherapy were enrolled. Stone burden, stone location, number of sessionsshockwaves, and auxiliary procedures were noted for each patient. Stones were located in the upper, middle, and lower calices of 35, 43, and 40, patients respectively, with mean stone burdens of 81.4 mm2, 75.2 mm2, and 96.3 mm2, respectively. Patients were evaluated with intravenous urography, plain film, or ultrasonography. Success was determined 3 months after the last session. Re-treatment rates were calculated. The effect of anatomic factors on the success of treatment for lower-caliceal stones also was determined.Results The mean stone burden, median number of treatment sessions, and mean number of shockwaves were 84.2 mm2, 2, and 4344, respectively. The auxiliary procedure rate was 16.1, and the re-treatment rate was 71.2. Failure was noted in 26 patients (22). The stone-free rates for stones in the upper, middle, and lower calices were 82.8, 83.4, and 67.5, respectively (P 0.14). The stone-free rates for stones <100 mm2and 100 to 200 mm2were 91.2 and 65.5, respectively (P 0.001). The efficiency quotient was 49.8, 44.8, and 32.5 for upper-, middle-, and lower-caliceal stones, respectively. Infundibular length (P 0.006) and infundibular width (P 0.036) were significant in determining the stone-free rate after treatment of lower-caliceal stones.Conclusions We recommend SWL as the first choice for treatment of stones <200 mm2in the upper and middle calices. Extracorporeal lithotripsy is one of the options for lower-caliceal stones <200 mm2but has high re-treatment and auxiliary-procedure rates in these cases. [ABSTRACT FROM AUTHOR]

Published
2007
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11. Rapid Communication How Do Increasing Stone Surface Area and Stone Configuration Affect Overall Outcome of Percutaneous Nephrolithotomy.

Author

Burak Turna, Mehmet Umul, Serkan Demiryoguran, Baris Altay, and Oktay Nazli

Subjects
BLOOD transfusion, BLOOD groups, KIDNEY stones, MEDICAL care
Abstract

Background and Purpose Studies reporting the outcome of percutaneous nephrolithotomy (PCNL) in relation to stone burden and configuration are limited. We analyzed our stone-free and complication rates of PCNL with regard to stone surface area and configuration.Patients and Methods Data of 234 patients who underwent PCNL were analyzed retrospectively. Patients were stratified into six groups according to stone burden and into four groups in relation to stone configuration. Groups were compared with respect to the number of tracts, success of therapy, complications, requirement for secondary procedures, drop in hematocrit, and blood transfusion requirement.Results The overall stone-free rate was 78.6 with a complication rate of 34.6. Stone-free rates decreased with increasing stone size (P 0.001) and with increasing caliceal component in complex stones (P 0.01). The total number of complications rose with increasing stone surface area (P 0.0001); however, stone distribution within the kidney did not affect the complication rate (P 0.2). The mean operative time rose with increasing stone burden (P< 0.05) and increasing caliceal involvement by complex stones (P< 0.01). The need for multiple tracts also rose with increasing stone burden (P< 0.05).Conclusion There is a decrease in the overall stone-free rate, as well as an increase in the complication rate, the secondary procedure rate, the mean operative time, and the need for multiple tracts, with increasing stone surface area with PCNL. With regard to stone configuration, there is a decrease in the stone-free rate, as well as an increase in the operative time, with increasing caliceal component in complex renal stones. [ABSTRACT FROM AUTHOR]

Published
2007
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