ArticleThe world journal of men's health2023
Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
Open access · diamondAbstract read
In one paragraph
Article in The world journal of men's health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
5.5field-weighted citation impact, top 4% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 20 citations in OpenAlex.
- Areas of Controversy and Confusion in Male Infertility: A Call for Clarity.The world journal of men's health · 2026Article
- Flow cytometry sperm apoptosis test can predict sperm DNA fragmentation and can be used as an effective and easy-to-perform screening method for males from infertile couples.Translational andrology and urology · 2026Article
- Sequencing Matters: Comparative Effectiveness of Density-Gradient Centrifugation and MACS for Enhancing Sperm Quality and DNA Integrity.Journal of clinical medicine · 2026Article
- Cumulative pregnancy and cumulative live birth rates and perinatal and obstetric outcomes in POSEIDON patients: insights from 19,371 IVF/ICSI cycles.Archives of gynecology and obstetrics · 2026Article
- Oxidative Stress, Sperm DNA Fragmentation, or Both? Optimizing Test Selection in Male Infertility Evaluation.Antioxidants (Basel, Switzerland) · 2026Review
- Evaluating the potential for sperm DNA fragmentation testing to guide the use of ICSI for couples with non-severe male infertility.Human reproduction open · 2026Article
- Global Andrology Forum Clinical Guidelines on the Relevance of Sperm DNA Fragmentation in Reproductive Medicine.The world journal of men's health · 2026Article
- Reducing Quotation Errors in Scientific Manuscripts: A Novel Approach from the Global Andrology Forum.The world journal of men's health · 2025Article
- High sperm DNA fragmentation - finding a needle in the haystack: tips on selecting the best sperm for ICSI and ART.Asian journal of andrology · 2025Article
- Revolutionizing Andrology: The Advent of the Global Andrology Forum, a Groundbreaking Initiative.The world journal of men's health · 2025Article
- Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.The world journal of men's health · 2024Article
- The Sperm DNA Fragmentation Assay with SDF Level Less Than 15% Provides a Useful Prediction for Clinical Pregnancy and Live Birth for Women Aged under 40 Years.Journal of personalized medicine · 2023Article
- Varicocele: To Treat or Not to Treat?Journal of clinical medicine · 2023Review
- Sperm DNA fragmentation in male infertility: From bench to bedside.Arab journal of urology · 2023Review
- Sperm DNA fragmentation testing in clinical management of reproductive medicine.Reproductive medicine and biologyReview
- Efficacy of Various Sperm Selection Strategies in Obtaining Sperm with Improved DNA Integrity: A Prospective Study.American journal of men's healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
164 authors at 20 institutions in 47 countries.
Ala'a FarkouhGlobal Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA.ORCID https://orcid.org/0000-0002-0362-9109
Ashok AgarwalGlobal Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA.ORCID https://orcid.org/0000-0003-0585-1026
Taha Abo-Almagd Abdel-Meguid HamodaDepartment of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.ORCID https://orcid.org/0000-0002-8070-4088
Parviz KavoussiDepartment of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.ORCID https://orcid.org/0000-0001-7390-5837
Ramadan SalehDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.ORCID https://orcid.org/0000-0003-0503-3533
Armand ZiniDepartment of Surgery, McGill University, Montreal, QC, Canada.ORCID https://orcid.org/0000-0002-2194-5578
Mohamed ArafaDepartment of Urology, Hamad Medical Corporation, Doha, Qatar.ORCID https://orcid.org/0000-0003-0107-8857
Ahmed M HarrazUrology Department, Urology and Nephrology Center, Mansoura University, Mansura, Egypt.ORCID https://orcid.org/0000-0002-8902-517X
Murat GulDepartment of Urology, Selçuk University School of Medicine, Konya, Turkey.ORCID https://orcid.org/0000-0002-6657-6227
Vilvapathy Senguttuvan KarthikeyanAndrology Unit, Department of Urology, Apollo Hospitals, Chennai, India.ORCID https://orcid.org/0000-0002-0244-476X
Damayanthi DurairajanayagamDepartment of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.ORCID https://orcid.org/0000-0001-9049-0215
Amarnath RambhatlaDepartment of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA.ORCID https://orcid.org/0000-0002-1383-6670
Florence BoitrelleReproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.ORCID https://orcid.org/0000-0002-5322-0141
Eric ChungDepartment of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.ORCID https://orcid.org/0000-0003-3373-3668
Ponco BirowoDepartment of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.ORCID https://orcid.org/0000-0003-2934-6753
Tuncay ToprakDepartment of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.ORCID https://orcid.org/0000-0003-1348-5273
Ramy Abou GhaydaUrology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.ORCID https://orcid.org/0000-0002-5170-3983
Rossella CannarellaDepartment of Clinical and Experimental Medicine, University of Catania, Catania, Italy.ORCID https://orcid.org/0000-0003-4599-8487
Nguyen Ho Vinh PhuocDepartment of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.ORCID https://orcid.org/0000-0002-4348-6034
Fotios DimitriadisDepartment of Urology, Aristotle University, School of Medicine, Thessaloniki, .ORCID https://orcid.org/0000-0003-1198-9144
Giorgio I RussoUrology Section, University of Catania, Catania, Italy.ORCID https://orcid.org/0000-0003-4687-7353
Ioannis SokolakisDepartment of Urology, Aristotle University, School of Medicine, Thessaloniki, .ORCID https://orcid.org/0000-0002-1938-8004
Taymour MostafaDepartment of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt.ORCID https://orcid.org/0000-0003-3627-0662
Konstantinos MakarounisDepartment of Urology and Andrology, Locus Medicus, Athens, Greece.ORCID https://orcid.org/0000-0002-3971-8330
Imad ZiouziouDepartment of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco.ORCID https://orcid.org/0000-0002-9844-6080
Shinnosuke KurodaDepartment of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.ORCID https://orcid.org/0000-0001-8890-0297
Marion BendayanReproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.ORCID https://orcid.org/0000-0003-1633-7735
Raneen Sawaid KaiyalDepartment of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.ORCID https://orcid.org/0000-0002-3111-3978
Andrian JapariFertility Clinic, Telogorejo Hospital, Semarang, Indonesia.ORCID https://orcid.org/0000-0003-4733-6313
Mara SimopoulouDepartment of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0002-1000-9100
Lucia RoccoDepartment of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.ORCID https://orcid.org/0000-0001-6250-4798
Nicolas GarridoIVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.ORCID https://orcid.org/0000-0001-8271-5218
Nazim GherabiDepartment of Urology, University of Algiers, Algiers, Algeria.ORCID https://orcid.org/0000-0001-7364-047X
Kadir BocuDepartment of Urology, Silopi State Hospital, Sirnak, Turkey.ORCID https://orcid.org/0000-0003-4323-4037
Oguzhan KahramanDepartment of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey.ORCID https://orcid.org/0000-0003-3691-8617
Tan V LeDepartment of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.ORCID https://orcid.org/0000-0003-1766-7453
Christine WynsCliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.ORCID https://orcid.org/0000-0002-6581-5003
Kelton TremellenDepartment of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, South Australia, Australia.ORCID https://orcid.org/0000-0001-5575-6049
Selcuk SarikayaDepartment of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.ORCID https://orcid.org/0000-0001-6426-1398
Sheena LewisExamen Lab Ltd., Northern Ireland, UK.ORCID https://orcid.org/0000-0001-5665-1572
Donald P EvensonSCSA Diagnostics, Brookings, SDUSA, USA.ORCID https://orcid.org/0000-0002-5361-8299
Edmund KoDepartment of Urology, Loma Linda University Health, Loma Linda, CA, USA.ORCID https://orcid.org/0000-0002-7465-3616
Aldo E CalogeroDepartment of Clinical and Experimental Medicine, University of Catania, Catania, Italy.ORCID https://orcid.org/0000-0001-6950-335X
Fahmi BaharAndrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia.ORCID https://orcid.org/0000-0002-7027-9436
Marlon MartinezSection of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines.ORCID https://orcid.org/0000-0002-1191-8154
Andrea CrafaDepartment of Clinical and Experimental Medicine, University of Catania, Catania, Italy.ORCID https://orcid.org/0000-0002-8311-9095
Quang NguyenCenter for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam.ORCID https://orcid.org/0000-0002-1670-8885
Rafael F AmbarDepartment of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil.ORCID https://orcid.org/0000-0002-3496-2895
Giovanni ColpiAndrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland.ORCID https://orcid.org/0000-0003-1431-1777
Mustafa Emre BakirciogluSENSART Clinic, Urology, Fulya, Istanbul, Turkey.ORCID https://orcid.org/0000-0003-2411-9703
Ralf HenkelDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.ORCID https://orcid.org/0000-0003-1128-2982
Hussein KandilFakih IVF Fertility Center, Abu Dhabi, UAE.ORCID https://orcid.org/0000-0002-5549-3274
Ege Can SerefogluDepartment of Urology, Biruni University School of Medicine, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-2530-7012
Abdullah AlarbidDepartment of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait.ORCID https://orcid.org/0000-0003-4822-9587
Akira TsujimuraDepartment of Urology, Juntendo University Urayasu Hospital, Chiba, Japan.ORCID https://orcid.org/0000-0002-3821-5184
Alireza KheradmandUrology Department, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.ORCID https://orcid.org/0000-0002-4978-6935
Christina AnagnostopoulouUnit of Reproductive Medicine-EmbryoART, Leto Maternity Hospital, Athens, Greece.ORCID https://orcid.org/0000-0003-0999-6484
Angelo MarinoANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy.ORCID https://orcid.org/0000-0002-3558-8153
Aram AdamyanIVF Department, Astghik Medical Center, Yerevan, Armenia.ORCID https://orcid.org/0000-0002-7213-7212
Birute ZilaitieneInstitute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.ORCID https://orcid.org/0000-0002-4082-4843
Cevahir OzerDepartment of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey.ORCID https://orcid.org/0000-0002-7850-6912
Edoardo PescatoriAndrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy.ORCID https://orcid.org/0000-0002-9326-5598
Paraskevi VogiatziAndromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece.ORCID https://orcid.org/0000-0001-9971-1619
Gian Maria BusettoDepartment of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy.ORCID https://orcid.org/0000-0002-7291-0316
Giancarlo BalerciaDepartment of Endocrinology, Polytechnic University of Marche, Ancona, Italy.ORCID https://orcid.org/0000-0003-1286-1521
Haitham ElbardisiDepartment of Urology, Hamad Medical Corporation, Doha, Qatar.ORCID https://orcid.org/0000-0003-3902-7924
Hamed AkhavizadeganDepartment of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.ORCID https://orcid.org/0000-0002-5432-7311
Hesamoddin SajadiDepartment of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Teheran, Iran.ORCID https://orcid.org/0000-0002-7198-0312
Hisanori TaniguchiDepartment of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan.ORCID https://orcid.org/0000-0002-7404-0369
Hyun Jun ParkDepartment of Urology, Pusan National University School of Medicine, Busan, Korea.ORCID https://orcid.org/0000-0003-0566-9574
Israel Maldonado RosasIVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico.ORCID https://orcid.org/0000-0003-2765-6176
Mohamed Al-MarhoonDivision of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Sultanate of Oman.ORCID https://orcid.org/0000-0002-8397-1560
Mohammad Ali Sadighi GilaniDepartment of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Teheran, Iran.ORCID https://orcid.org/0000-0001-6168-8599
Naif AlhathalKing Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.ORCID https://orcid.org/0000-0001-7516-3187
Germar-Michael PinggeraDepartment of Urology, Innsbruck Medical University, Innsbruck, Austria.ORCID https://orcid.org/0000-0001-6463-2494
Priyank KothariDepartment of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India.ORCID https://orcid.org/0000-0002-3940-952X
Nasser MogharabianSexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.ORCID https://orcid.org/0000-0001-8795-973X
Sava MicicDepartment of Andrology, Uromedica Polyclinic, Belgrade, Serbia.ORCID https://orcid.org/0000-0001-9037-3318
Sheryl HomaDepartment of Biosciences, University of Kent, Canterbury, UK.ORCID https://orcid.org/0000-0001-5027-0066
Sara DarbandiFetal Health Research Center, Hope Generation Foundation, Tehran, Iran.ORCID https://orcid.org/0000-0002-1868-6712
Tran Quang Tien LongDepartment of Obstetrics and Gynecology, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.ORCID https://orcid.org/0000-0001-8905-3130
Wael ZohdyDepartment of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt.ORCID https://orcid.org/0000-0002-3100-929X
Widi AtmokoDepartment of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.ORCID https://orcid.org/0000-0002-7793-7083
Marjan SabbaghianDepartment of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Teheran, Iran.ORCID https://orcid.org/0000-0001-9439-268X
Wael IbrahimDepartment of Obstetrics Gynaecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt.ORCID https://orcid.org/0000-0002-1651-8598
Ryan P SmithDepartment of Urology, University of Virginia School of Medicine, Virginia, USA.ORCID https://orcid.org/0000-0002-3880-9740
Christopher Chee Kong HoDepartment of Surgery, School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia.ORCID https://orcid.org/0000-0002-8757-6867
Jean de la RosetteDepartment of Urology, Istanbul Medipol University, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-6308-1763
Ahmed I El-SakkaDepartment of Urology, Suez Canal University, Ismailia, Egypt.ORCID https://orcid.org/0000-0001-8671-5952
Mirko PretoDepartment of Urology, University of Turin, Turin, Italy.ORCID https://orcid.org/0000-0002-8144-6498
Cătălina Zenoaga-BarbăroșieDepartment of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania.ORCID https://orcid.org/0000-0002-2854-9834
Saad Mohammed AbumelhaDivision of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.ORCID https://orcid.org/0000-0003-1885-3856
Aykut BaserDepartment of Urology, Bandirma Onyedi Eylül University, Balikesir, Turkey.ORCID https://orcid.org/0000-0003-0457-512X
Kaan AydosDepartment of Urology, Ankara University, Ankara, Turkey.ORCID https://orcid.org/0000-0001-7691-5459
Liliana Ramirez-DominguezIVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico.ORCID https://orcid.org/0000-0002-8596-0654
Vijay KumarDepartment of Microbiology, Kurukshetra University, Kurukshetra, India.ORCID https://orcid.org/0000-0003-3768-8104
Teng Aik OngDepartment of Surgery, University of Malaya, Kuala Lumpur, Malaysia.ORCID https://orcid.org/0000-0002-0207-8966
Tiago Cesar MierzwaAndrolab, Fertility Clinic, Curitiba, PR, Brazil.ORCID https://orcid.org/0000-0001-7574-9540
Ricky AdriansjahDepartment of Urology, Faculty of Medicine of Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia.ORCID https://orcid.org/0000-0002-9733-3092
Saleem A BanihaniDepartment of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan.ORCID https://orcid.org/0000-0002-6830-6247
Kasonde BowaDepartment of Urology, University of Lusaka, Lusaka, Zambia.ORCID https://orcid.org/0000-0001-7032-7998
Shinichiro FukuharaDepartment of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan.ORCID https://orcid.org/0000-0003-1336-4316
Marcelo Rodriguez PeñaInstituto de Ginecologia y Fertilidad (IFER), Buenos Aire, Argentina.ORCID https://orcid.org/0000-0003-2437-7833
Mohamad MoussaDepartment of Urology, Lebanese University, Beirut, Lebanon.ORCID https://orcid.org/0000-0001-8571-2768
Umut Çağın AriDepartment of Reproduction, Kafkas University, Kars, Turkey.ORCID https://orcid.org/0000-0002-7089-6522
Chak-Lam ChoS. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong.ORCID https://orcid.org/0000-0003-2520-6833
Nicholas N TadrosDivision of Urology, Southern Illinois University, Springfield, IL, USA.ORCID https://orcid.org/0000-0002-2272-235X
Muhammet Rasit UgurIVF Michigan, Bloomfield Hills, MI, USA.ORCID https://orcid.org/0000-0003-1234-6693
Edouard AmarAmerican Hospital of Paris, Paris, France.ORCID https://orcid.org/0000-0002-0617-8024
Marco FalconeDepartment of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy.ORCID https://orcid.org/0000-0003-1101-892X
Frederic Romain SanterDepartment of Urology, Innsbruck Medical University, Innsbruck, Austria.ORCID https://orcid.org/0000-0002-4591-6368
Arif KalkanliDepartment of Urology, Taksim Education and Research Hospital, Istanbul, Turkey.ORCID https://orcid.org/0000-0001-6509-4720
Keshab Kumar KarnaDepartment of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA.ORCID https://orcid.org/0000-0003-1389-8975
Kareim KhalafallaDepartment of Urology, Hamad Medical Corporation, Doha, Qatar.ORCID https://orcid.org/0000-0001-9476-4869
Ranjit B VishwakarmaDivision of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.ORCID https://orcid.org/0000-0002-6784-2830
Federica FinocchiDepartment of Endocrinology, Polytechnic University of Marche, Ancona, Italy.ORCID https://orcid.org/0000-0003-1551-5990
Carlo GiulioniDepartment of Urology, Polytechnic University of Marche Region, Ancona, Italy.ORCID https://orcid.org/0000-0001-9934-4011
Erman CeyhanDepartment of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey.ORCID https://orcid.org/0000-0001-8223-6399
Gökhan ÇekerDepartment of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-7891-9450
Chadi YazbeckObstetrics Gynecology and Reproductive Medicine, Reprogynes Medical Institute, Paris, France.ORCID https://orcid.org/0000-0002-5759-7771
Osvaldo RajmilDepartment of Andrology, Fundacio Puigvert, Barcelona, Spain.ORCID https://orcid.org/0000-0003-1987-9206
Mehmet YilmazAsklepios Clinic Triberg, Urology, Freiburg, Germany.ORCID https://orcid.org/0000-0003-3774-9982
Baris AltayDepartment of Urology, Ege University, Izmir, Turkey.ORCID https://orcid.org/0000-0002-3101-8022
Trenton L BarrettPerth Urology Clinic, Perth, WA, Australia.ORCID https://orcid.org/0000-0001-5838-8309
Kay Seong NgooHospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia.ORCID https://orcid.org/0000-0003-2787-3963
Shubhadeep RoychoudhuryDepartment of Life Science and Bioinformatics, Assam University, Silchar, India.ORCID https://orcid.org/0000-0003-4174-1852
Gianmaria SalvioDepartment of Endocrinology, Polytechnic University of Marche, Ancona, Italy.ORCID https://orcid.org/0000-0001-9290-5699
Haocheng LinDepartment of Urology, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0000-0002-5333-6611
Ates KadiogluSection of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-4239-7638
Massimiliano TimpanoDepartment of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy.ORCID https://orcid.org/0000-0002-2507-6728
Tomer Avidor-ReissDepartment of Biological Sciences, University of Toledo, Toledo, OH, USA.ORCID https://orcid.org/0000-0003-0918-526X
Lukman HakimDepartment of Urology, Universitas Airlangga, Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.ORCID https://orcid.org/0000-0003-1518-8010
Puneet SindhwaniDepartment of Urology, Universitas Airlangga, Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.ORCID https://orcid.org/0000-0002-9420-2978
Giorgio FrancoDepartment of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.ORCID https://orcid.org/0000-0003-3653-3389
Rajender SinghDivision of Endocrinology, Central Drug Research Institute, Lucknow, India.ORCID https://orcid.org/0000-0002-4592-6566
Filippo GiaconeCentro HERA, Unità di Medicina della Riproduzione, Sant'Agata Li Battiati, Catania, Italy.ORCID https://orcid.org/0000-0003-0510-4039
Mikhail RuzaevPrivate Clinic, Moscow, Russia.ORCID https://orcid.org/0000-0001-5258-2813
Raghavender KosgiDepartment of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India.ORCID https://orcid.org/0000-0002-2178-0857
Nikolaos SofikitisDepartment of Urology, Ioannina University School of Medicine, Ioannina, Greece.ORCID https://orcid.org/0000-0003-1528-4029
Ayad PalaniResearch Centre, University of Garmian, Kalar, Iraq.ORCID https://orcid.org/0000-0001-7806-9903
Gokhan CalikDepartment of Urology, Istanbul Medipol University, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-9976-9666
Deniz KulaksızDepartment of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey.ORCID https://orcid.org/0000-0003-2351-1367
Davor JezekDepartment for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University Hospital Zagreb, Zagreb, Croatia.ORCID https://orcid.org/0000-0002-1528-5462
Manaf Al HashmiDepartment of Urology, Burjeel Hospital, Abu Dhabi, UAE.ORCID https://orcid.org/0000-0002-2458-179X
Panagiotis DrakopoulosCentre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.ORCID https://orcid.org/0000-0002-9262-785X
Huda OmranAl Aljenan Medical Center, Pulse Health Training Center, Manama, Kingdom of Bahrain.ORCID https://orcid.org/0000-0002-5809-5087
Sofia LeonardiCentral Laboratory, Hospital Público Materno Infantil de Salta, Salta, Argentina.ORCID https://orcid.org/0000-0003-4334-2556
Ciler Celik-OzenciDepartment of Histology and Embryology, Faculty of Medicine, Koç University, Istanbul, Turkey.ORCID https://orcid.org/0000-0003-0370-8680
Nur Dokuzeylül GüngörDepartment of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-7234-3876
Jonathan RamsayDepartment of Andrology, Hammersmith Hospital, London, UK.ORCID https://orcid.org/0000-0002-2403-7698
Toshiyasu AmanoDepartment of Urology, Nagano Red Cross Hospital, Nagano, Japan.ORCID https://orcid.org/0000-0002-9640-8718
Emrullah SogutdelenDepartment of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey.ORCID https://orcid.org/0000-0002-1454-5672
Gede Wirya Kusuma DuarsaDepartment of Urology, Udayana University, Denpasar, Indonesia.ORCID https://orcid.org/0000-0002-0642-159X
Koji ChibaDepartment of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.ORCID https://orcid.org/0000-0001-5575-0667
Sunil JindalDepartment of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India.ORCID https://orcid.org/0000-0002-8088-8710
Missy SaviraDepartment of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.ORCID https://orcid.org/0000-0002-3492-432X
Luca BoeriDepartment of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.ORCID https://orcid.org/0000-0003-0040-784X
Edson BorgesFertility Assisted Fertilization Center, São Paulo, Brazil.ORCID https://orcid.org/0000-0002-4971-1925
Deepak GupteDepartment of Urology, Bombay Hospital and Medical Research Center, Mumbai, India.ORCID https://orcid.org/0000-0002-8522-2299
Fatih GokalpDepartment of Urology, Hatay Mustafa Kemal University, Antakya, Turkey.ORCID https://orcid.org/0000-0003-3099-3317
Guadalupe Hernández HebrardIVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico.ORCID https://orcid.org/0000-0002-1739-8882
Suks MinhasDivision of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.ORCID https://orcid.org/0000-0001-6516-619X
Rupin ShahDivision of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.ORCID https://orcid.org/0000-0002-7868-5949
Global Andrology Forum
Cairo University · EGCleveland Clinic · USMarche Polytechnic University · ITBaşkent University · TRInformation Group on Reproductive Choice · MXRoyan Institute · IRUniversity of Catania · ITUniversity of Indonesia · IDAirlangga University · IDAristotle University of Thessaloniki · GRFertility Medical Group · BRFondazione Ricerca Molinette · ITImperial College London · GBInnsbruck Medical University · ATIstanbul Medipol University · TRLilavati Hospital & Research Centre · INPham Ngoc Thach University of Medicine · VNSağlık Bilimleri Üniversitesi · TRAgricultural Plant Physiology and Ecology Research Institute · ARAhvaz Jundishapur University of Medical Sciences · IR
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeSperm 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
methodsAn 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.
resultsA 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.
conclusionsThis 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.
Indexed as
Delphi methodDisease managementDNA fragmentationMale infertilityPractice guidelineSurvey
Identifiers
What OpenQuestion holds
Textmetadata
LicenceCC BY-NC
Read underepoch 390
Registered trials
None linked
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.