Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
DNA fragmentation
Delphi method
Disease management
Male infertility
Practice guideline
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:
Oct 2023
Oct 2023
Historique:
received:
12
01
2023
revised:
18
01
2023
accepted:
27
01
2023
medline:
29
4
2023
pubmed:
29
4
2023
entrez:
29
4
2023
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 37118965
pii: 41.e48
doi: 10.5534/wjmh.230008
pmc: PMC10523126
doi:
Types de publication
Journal Article
Langues
eng
Pagination
809-847Informations 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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