Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.

Fecha de publicación: 20/04/2023 Fecha Ahead of Print: 20/04/2023

Autores de IIS La Fe

Nicolás Garrido Puchalt

Autor

Participantes ajenos a IIS La Fe

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
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
Darbandi, Sara
Long, Tran Quang Tien
Zohdy, Wael
Atmoko, Widi
Sabbaghian, Marjan
Ibrahim, Wael
Smith, Ryan P
Ho, Christopher Chee Kong
de la Rosette, Jean
El-Sakka, Ahmed I
Preto, Mirko
Zenoaga-Barbaro?ie, Catalina
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
Pena, Marcelo Rodriguez
Moussa, Mohamad
Ari, Umut Cagin
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
Ceker, Gokhan
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
Kulaksiz, Deniz
Jezek, Davor
Al Hashmi, Manaf
Drakopoulos, Panagiotis
Omran, Huda
Leonardi, Sofia
Celik-Ozenci, Ciler
Gungor, Nur Dokuzeylul
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 Hernandez
Minhas, Suks
Shah, Rupin
Global Andrology Forum

Grupos

Biología Reproductiva y Bioingeniería en Reproducción Humana

Leader

Nicolás Garrido Puchalt

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.