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.authoridAL HASHIMI, MANAF/0000-0002-2458-179X
dc.authoridCeker, Gokhan/0000-0002-7891-9450
dc.authoridHoma, Sheryl/0000-0001-5027-0066
dc.authoridAdriansjah, Ricky/0000-0002-9733-3092
dc.authoridKumar, Vijay/0000-0003-3768-8104
dc.authoridMarino, Angelo/0000-0002-3558-8153
dc.authoridYAZBECK, CHADI/0000-0002-5759-7771
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.authorZini, Armand
dc.contributor.authorArafa, Mohamed
dc.date.accessioned2024-09-18T20:15:03Z
dc.date.available2024-09-18T20:15:03Z
dc.date.issued2023
dc.departmentHatay Mustafa Kemal Üniversitesien_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.doi10.5534/wjmh.230008
dc.identifier.endpage847en_US
dc.identifier.issn2287-4208
dc.identifier.issn2287-4690
dc.identifier.issue4en_US
dc.identifier.pmid37118965en_US
dc.identifier.scopus2-s2.0-85163745039en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage809en_US
dc.identifier.urihttps://doi.org/10.5534/wjmh.230008
dc.identifier.urihttps://hdl.handle.net/20.500.12483/9414
dc.identifier.volume41en_US
dc.identifier.wosWOS:000992530900001en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherKorean Soc Sexual Medicine & 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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