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

Fecha de publicación: 01/01/2024 Fecha Ahead of Print: 01/08/2023

Autores de IIS La Fe

Nicolás Garrido Puchalt

Autor

Participantes ajenos a IIS La Fe

Agarwal A
Farkouh A
Saleh R
Hamoda TAA
Salvio G
Boitrelle F
Harraz AM
Ghayda RA
Kavoussi P
Gül M
Toprak T
Russo GI
Durairajanayagam D
Rambhatla A
Birowo P
Cannarella R
Phuoc NHV
Zini A
Arafa M
Wyns C
Tremellen K
Sarikaya S
Lewis S
Evenson DP
Ko E
Calogero AE
Bahar F
Martínez M
Ambar RF
Colpi GM
Bakircioglu ME
Henkel R
Kandil H
Serefoglu EC
Alfakhri A
Tsujimura A
Kheradmand A
Marino A
Adamyan A
Zilaitiene B
Ozer C
Pescatori E
Vogiatzi P
Busetto GM
Balercia G
Elbardisi H
Akhavizadegan H
Sajadi H
Taniguchi H
Park HJ
Maldonado Rosas I
Al-Marhoon M
Sadighi Gilani MA
Alhathal N
Quang N
Pinggera GM
Kothari P
Micic S
Homa S
Long TQT
Zohdy W
Atmoko W
Ibrahim W
Sabbaghian M
Abumelha SM
Chung E
Ugur MR
Ozkent MS
Selim O
Darbandi M
Fukuhara S
Jamali M
de la Rosette J
Kuroda S
Smith RP
Baser A
Kalkanli A
Tadros NN
Aydos K
Mierzwa TC
Khalafalla K
Malhotra V
Moussa M
Finocchi F
Rachman RI
Giulioni C
Avidor-Reiss T
Kahraman O
Çeker G
Zenoaga-Barbaro?ie C
Barrett TL
Yilmaz M
Kadioglu A
Jindal S
Omran H
Bocu K
Karthikeyan VS
Franco G
Solorzano JF
Vishwakarma RB
Arianto E
Jain D
Gherabi N
Sokolakis I
Palani A
Calik G
Kulaksiz D
Simanaviciene V
Simopoulou M
Güngör ND
Blecher G
Falcone M
Jezek D
Preto M
Amar E
Le TV
Ahn ST
Rezano A
Singh K
Rocco L
Savira M
Rajmil O
Darbandi S
Sogutdelen E
Boeri L
Hernández G
Hakim L
Morimoto Y
Japari A
Sofikitis N
Altay B
Metin Mahmutoglu A
Al Hashimi M
Ziouziou I
Anagnostopoulou C
Lin H
Shah R

Grupos

Biología Reproductiva y Bioingeniería en Reproducción Humana

Leader

Nicolás Garrido Puchalt

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 exami-nation 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 profes-sional 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 deoxyuri-dine 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 in-fluenced 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 respon-dents 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 en-countered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory inter-pretation of SDF testing are crucial.

Datos de la publicación

ISSN/ISSNe:: 2287-4208, 2287-4690
Tipo:: Article
Páginas:: 202-215
DOI:: 10.5534/wjmh.230076
PubMed:: 37635341
Factor de Impacto:: 0,788 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

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Métricas

Filiaciones

Agarwal A:: Global Andrology Forum, Moreland Hills, OH, USA

Cleveland Clinic, Cleveland, OH, USA.
Farkouh A:: Global Andrology Forum, Moreland Hills, OH, USA
Saleh R:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
Hamoda TAA:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia

Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
Salvio G:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
Boitrelle F:: Global Andrology Forum, Moreland Hills, OH, USA

Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France

Department of Biology, Reproduction, Epigenetics, Environment, and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
Harraz AM:: Global Andrology Forum, Moreland Hills, OH, USA

Urology and Nephrology Center, Mansoura, Egypt

Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait

Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
Ghayda RA:: Global Andrology Forum, Moreland Hills, OH, USA

Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
Kavoussi P:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
Gül M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, SelÃ§uk University School of Medicine, Konya, Turkey
Toprak T:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
Russo GI:: Global Andrology Forum, Moreland Hills, OH, USA

Urology Section, University of Catania, Catania, Italy
Durairajanayagam D:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
Rambhatla A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
Birowo P:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Cannarella R:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
Phuoc NHV:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam

Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
Zini A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Surgery, McGill University, Montreal, QC, Canada
Arafa M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Hamad Medical Corporation, Doha, Qatar

Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar

Department of Andrology and STDs, Cairo University, Cairo, Egypt
Wyns C:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Universitat Catholique de Louvain, Brussels, Belgium
Tremellen K:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia
Sarikaya S:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Galhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
Lewis S:: Global Andrology Forum, Moreland Hills, OH, USA

Examen Lab Ltd., Northern Ireland, UK
Evenson DP:: Global Andrology Forum, Moreland Hills, OH, USA

SCSA Diagnostics, Brookings, SD, USA
Ko E:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
Calogero AE:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
Bahar F:: Global Andrology Forum, Moreland Hills, OH, USA

Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
Martínez M:: Global Andrology Forum, Moreland Hills, OH, USA

Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
Ambar RF:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Centro Universitario em Saude do ABC, Santo Andre, Brazil

Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil
Colpi GM:: Global Andrology Forum, Moreland Hills, OH, USA

Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
Bakircioglu ME:: Global Andrology Forum, Moreland Hills, OH, USA

SENSART Clinic, Urology, Fulya, Istanbul, Turkey
Henkel R:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK

Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
Kandil H:: Global Andrology Forum, Moreland Hills, OH, USA

Fakih IVF Fertility Center, Abu Dhabi, UAE
Serefoglu EC:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
Alfakhri A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
Tsujimura A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
Kheradmand A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Marino A:: Global Andrology Forum, Moreland Hills, OH, USA

Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy
Adamyan A:: Global Andrology Forum, Moreland Hills, OH, USA

IVF Department, Astghik Medical Center, Yerevan, Armenia
Zilaitiene B:: Global Andrology Forum, Moreland Hills, OH, USA

Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Ozer C:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
Pescatori E:: Global Andrology Forum, Moreland Hills, OH, USA

Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
Vogiatzi P:: Global Andrology Forum, Moreland Hills, OH, USA

Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece
Busetto GM:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
Balercia G:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
Elbardisi H:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Hamad Medical Corporation, Doha, Qatar

Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar

Department of Urology, College of Medicine, Qatar University, Doha, Qatar
Akhavizadegan H:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Sajadi H:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Taniguchi H:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
Park HJ:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Pusan National University School of Medicine, Busan, Korea

Medical Research Institute of Pusan National University Hospital, Busan, Korea
Maldonado Rosas I:: Global Andrology Forum, Moreland Hills, OH, USA

IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
Al-Marhoon M:: Global Andrology Forum, Moreland Hills, OH, USA
Sadighi Gilani MA:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Alhathal N:: Global Andrology Forum, Moreland Hills, OH, USA

King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Quang N:: Global Andrology Forum, Moreland Hills, OH, USA

Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam

Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
Pinggera GM:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Innsbruck Medical University, Innsbruck, Austria
Kothari P:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
Micic S:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
Homa S:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Biosciences, University of Kent, Canterbury, UK
Long TQT:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Vietnam
Zohdy W:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology and STDs, Cairo University, Cairo, Egypt
Atmoko W:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Ibrahim W:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Surgery, School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia
Sabbaghian M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Abumelha SM:: Global Andrology Forum, Moreland Hills, OH, USA

Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Chung E:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane QLD, Australia
Ugur MR:: Global Andrology Forum, Moreland Hills, OH, USA

IVF Michigan, Bloomfield Hills, MI, USA
Ozkent MS:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Konya City Hospital, Konya, Turkey
Selim O:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology and STDs, Cairo University, Cairo, Egypt
Darbandi M:: Global Andrology Forum, Moreland Hills, OH, USA

Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran

Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
Fukuhara S:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
Jamali M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Mohammed V Military Hospital, Rabat, Morocco
de la Rosette J:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Istanbul Medipol University, Istanbul, Turkey
Kuroda S:: Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
Smith RP:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
Baser A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Bandirma Onyedi Eylül University, Balikesir, Turkey
Kalkanli A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
Tadros NN:: Global Andrology Forum, Moreland Hills, OH, USA

Division of Urology, Southern Illinois University, Springfield, IL, USA
Aydos K:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Ankara University, Ankara, Turkey
Mierzwa TC:: Global Andrology Forum, Moreland Hills, OH, USA

Androlab, Fertility Clinic, Curitiba, PR, Brazil
Khalafalla K:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Hamad Medical Corporation, Doha, Qatar

Department of Urology, University of Texas McGovern Medical School, Houston, TX, USA

Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
Malhotra V:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, SCM Clinic and Hospital, New Delhi, India
Moussa M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Lebanese University, Beirut, Lebanon

Department of Urology, Al Zahraa Hospital, UMC, Lebanon
Finocchi F:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
Rachman RI:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Giulioni C:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
Avidor-Reiss T:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Biological Sciences, University of Toledo, Toledo, OH, USA

Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
Kahraman O:: Global Andrology Forum, Moreland Hills, OH, USA

Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
Çeker G:: Department of Urology, Basaksehir Çam and Sakura City Hospital, Istanbul, Turkey
Zenoaga-Barbaro?ie C:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
Barrett TL:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Perth Urology Clinic, Murdoch, WA, Australia
Yilmaz M:: Global Andrology Forum, Moreland Hills, OH, USA

Asklepios Klinik Triberg, Urology, Triberg, Germany
Kadioglu A:: Global Andrology Forum, Moreland Hills, OH, USA

Section of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey
Jindal S:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
Omran H:: Global Andrology Forum, Moreland Hills, OH, USA

Molecular Genetics Department, Pulse Health Training Center, Manama, Bahrain
Bocu K:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Silopi State Hospital, Sirnak, Turkey
Karthikeyan VS:: Global Andrology Forum, Moreland Hills, OH, USA

Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India
Franco G:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
Solorzano JF:: Global Andrology Forum, Moreland Hills, OH, USA

IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
Vishwakarma RB:: Global Andrology Forum, Moreland Hills, OH, USA

Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
Arianto E:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Surgery, Prof. Dr. R.D. Kandou Central General Hospital, Manado, Indonesia
Garrido N:: Global Andrology Forum, Moreland Hills, OH, USA

Instituto de Investigación. IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
Jain D:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Obstetrics and Gynecology, Jaipur Golden Hospital, New Delhi, India
Gherabi N:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Medicine, University of Algiers 1, Algiers, Algeria
Sokolakis I:: Global Andrology Forum, Moreland Hills, OH, USA

2nd Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Palani A:: Global Andrology Forum, Moreland Hills, OH, USA

Research Centre, University of Garmian, Kalar, Iraq
Calik G:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Istanbul Medipol University, Istanbul, Turkey
Kulaksiz D:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey
Simanaviciene V:: Global Andrology Forum, Moreland Hills, OH, USA

Fertility Centre, Northway Medical Centre, Vilnius, Lithuania
Simopoulou M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Güngör ND:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
Blecher G:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
Falcone M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Molinette Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
Jezek D:: Global Andrology Forum, Moreland Hills, OH, USA

Reproductive Tissue Bank, Department for Transfusion Medicine and Transplantation Biology, University Hospital Zagreb, Zagreb, Croatia
Preto M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Molinette Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
Amar E:: Global Andrology Forum, Moreland Hills, OH, USA

American Hospital of Paris, Paris, France
Le TV:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam

Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
Ahn ST:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Korea University College of Medicine, Seoul, Korea
Rezano A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Biomedical Sciences, Division of Cell Biology, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
Singh K:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Preclinical and Health Sciences, Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, St Michael, Barbados, Italy
Rocco L:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
Savira M:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Rajmil O:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Andrology, Fundacio Puigvert, Barcelona, Spain
Darbandi S:: Global Andrology Forum, Moreland Hills, OH, USA

Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran

Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
Sogutdelen E:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey
Boeri L:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
Hernández G:: Global Andrology Forum, Moreland Hills, OH, USA

IVF Department, CITMER Reproductive Medicine, Puebla, Mexico
Hakim L:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Faculty of Medicine, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
Morimoto Y:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, HORAC Grand Front Osaka Clinic, Osaka, Japan
Japari A:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Fertility Clinic, Telogorejo Hospital, Central Java, Indonesia
Sofikitis N:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
Altay B:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Ege University, Izmir, Turkey
Metin Mahmutoglu A:: Global Andrology Forum, Moreland Hills, OH, USA

Departmant of Medical Biology, Faculty of Medical, Yozgat Bozok University, Yozgat, Turkey
Al Hashimi M:: Global Andrology Forum, Moreland Hills, OH, USA
Ziouziou I:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, University Hospital of Souss Massa, Massa, Morocco
Anagnostopoulou C:: Global Andrology Forum, Moreland Hills, OH, USA

Unit of Reproductive Medicine, EmbryoART, Leto Maternity Hospital, Athens, Greece
Lin H:: Global Andrology Forum, Moreland Hills, OH, USA

Department of Urology, Peking University Third Hospital, Beijing, China
Shah R:: Global Andrology Forum, Moreland Hills, OH, USA

Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India