Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

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dc.authorid0000-0002-0362-9109en_US
dc.authorid0000-0003-0585-1026en_US
dc.authorid0000-0002-8070-4088en_US
dc.authorid0000-0001-7390-5837en_US
dc.authorid0000-0003-0503-3533en_US
dc.authorid0000-0002-1454-5672en_US
dc.contributor.authorFarkouh, Ala'a
dc.contributor.authorAgarwal, Ashok
dc.contributor.authorHamoda, Taha Abo-Almagd Abdel-Meguid
dc.contributor.authorKavoussi, Parviz
dc.contributor.authorSaleh, Ramadan
dc.contributor.authorSöğütdelen, Emrullah
dc.date.accessioned2023-09-08T10:53:55Z
dc.date.available2023-09-08T10:53:55Z
dc.date.issued2023en_US
dc.departmentBAİBÜ, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümüen_US
dc.description.abstractPurpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproduc-tive 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 clini-cians, 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 formu-lated 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 unex-plained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respon-dents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical vari-cocele, 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.en_US
dc.identifier.citationFarkouh, A., Agarwal, A., Hamoda, T. A. A. A. M., Kavoussi, P., Saleh, R., Zini, A., ... & Ramsay, J. (2023). Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. The World Journal of Men's Health, 41.en_US
dc.identifier.doi10.5534/wjmh.230008
dc.identifier.endpage39en_US
dc.identifier.issn2287-4208
dc.identifier.issn2287-4690
dc.identifier.pmid37118965en_US
dc.identifier.scopus2-s2.0-85163745039en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage1en_US
dc.identifier.urihttp://dx.doi.org/10.5534/wjmh.230008
dc.identifier.urihttps://hdl.handle.net/20.500.12491/11683
dc.identifier.wosWOS:000992530900001en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.institutionauthorSöğütdelen, Emrullah
dc.language.isoenen_US
dc.publisherKorean Society for Sexual Medicine and Andrologyen_US
dc.relation.ispartofWorld Journal of Mens Healthen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectDelphi Methoden_US
dc.subjectDisease Managementen_US
dc.subjectDNA Fragmentationen_US
dc.subjectMale Infertilityen_US
dc.subjectPractice Guidelineen_US
dc.subjectSurveyen_US
dc.titleControversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendationsen_US
dc.typeArticleen_US

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