Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
DNA fragmentation
Delphi method
Male infertility
Practice guidelines
Sperm
Survey
Journal
The world journal of men's health
ISSN: 2287-4208
Titre abrégé: World J Mens Health
Pays: Korea (South)
ID NLM: 101596899
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
23
12
2022
accepted:
02
01
2023
medline:
29
4
2023
pubmed:
29
4
2023
entrez:
29
4
2023
Statut:
ppublish
Résumé
Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.
Identifiants
pubmed: 37118960
pii: 41.e43
doi: 10.5534/wjmh.220282
pmc: PMC10307662
doi:
Types de publication
Journal Article
Langues
eng
Pagination
575-602Informations de copyright
Copyright © 2023 Korean Society for Sexual Medicine and Andrology.
Déclaration de conflit d'intérêts
The authors have nothing to disclose.
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