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

Authors :
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
Rupin Shah
Source :
The World Journal of Men's Health, Vol 42, Iss 1, Pp 202-215 (2024)
Publication Year :
2024
Publisher :
Korean Society for Sexual Medicine and Andrology, 2024.

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.

Details

Language :
English
ISSN :
22874208 and 22874690
Volume :
42
Issue :
1
Database :
Directory of Open Access Journals
Journal :
The World Journal of Men's Health
Publication Type :
Academic Journal
Accession number :
edsdoj.8695d13e7b43d7b6959e7d19491edb
Document Type :
article
Full Text :
https://doi.org/10.5534/wjmh.230076