Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Professional paper - Professional paper

• Author: Ashok Agarwal
• Author: Ala’a Farkouh
• Author: Ramadan Saleh
• Author: Taha Abo-Almagd Abdel-Meguid Hamoda
• Author: Gianmaria Salvio
• Author: Florence Boitrelle
• Author: Ahmed M. Harraz
• Author: Ramy Abou Ghayda
• Author: Parviz Kavoussi
• Author: Murat Gül
• Author: Tuncay Toprak
• Author: Giorgio Ivan Russo
• Author: Damayanthi Durairajanayagam
• Author: Amarnath Rambhatla
• Author: Ponco Birowo
• Author: Rossella Cannarella
• Author: Nguyen Ho Vinh Phuoc
• Author: Armand Zini
• Author: Mohamed Arafa
• Author: Christine Wyns
• Author: Kelton Tremellen
• Author: Selçuk Sarıkaya
• Author: Sheena Lewis
• Author: Donald P. Evenson
• Author: Edmund Ko
• Author: Aldo E. Calogero
• Author: Fahmi Bahar
• Author: Marlon Martínez
• Author: Rafael F. Ambar
• Author: Giovanni M. Colpi
• Author: Mustafa Emre Bakircioglu
• Author: Ralf Henkel
• Author: Hussein Kandil
• Author: Ege Can Serefoglu
• Author: Abdullah Alfakhri
• Author: Akira Tsujimura
• Author: Alireza Kheradmand
• Author: Angelo Marino
• Author: Aram Adamyan
• Author: Birute Zilaitiene
• Author: Cevahir Ozer
• Author: Edoardo Pescatori
• Author: Paraskevi Vogiatzi
• Author: Gian Maria Busetto
• Author: Giancarlo Balercia
• Author: Haitham Elbardisi
• Author: Hamed Akhavizadegan
• Author: Hesamoddin Sajadi
• Author: Hisanori Taniguchi
• Author: Hyun Jun Park
• Author: Israel Maldonado Rosas
• Author: Mohamed Al-Marhoon
• Author: Mohammad Ali Sadighi Gilani
• Author: Naif Alhathal
• Author: Nguyen Quang
• Author: Germar-Michael Pinggera
• Author: Priyank Kothari
• Author: Sava Micic
• Author: Sheryl Homa
• Author: Tran Quang Tien Long
• Author: Wael Zohdy
• Author: Widi Atmoko
• Author: Wael Ibrahim
• Author: Marjan Sabbaghian
• Author: Saad Mohammed Abumelha
• Author: Eric Chung
• Author: Muhammet Rasit Ugur
• Author: Mehmet Serkan Ozkent
• Author: Osama Selim
• Author: Mahsa Darbandi
• Author: Shinichiro Fukuhara
• Author: Mounir Jamali
• Author: Jean de la Rosette
• Author: Shinnosuke Kuroda
• Author: Ryan P. Smith
• Author: Aykut Baser
• Author: Arif Kalkanli
• Author: Nicholas N. Tadros
• Author: Kaan Aydos
• Author: Tiago Cesar Mierzwa
• Author: Kareim Khalafalla
• Author: Vineet Malhotra
• Author: Mohamad Moussa
• Author: Federica Finocchi
• Author: Rinaldo Indra Rachman
• Author: Carlo Giulioni
• Author: Tomer Avidor-Reiss
• Author: Oguzhan Kahraman
• Author: Gökhan Çeker
• Author: Cătălina Zenoaga-Barbăroşie
• Author: Trenton L. Barrett
• Author: Mehmet Yilmaz
• Author: Ates Kadioglu
• Author: Sunil Jindal
• Author: Huda Omran
• Author: Kadir Bocu
• Author: Vilvapathy Senguttuvan Karthikeyan
• Author: Giorgio Franco
• Author: Jesús Fernando Solorzano
• Author: Ranjit B. Vishwakarma
• Author: Eko Arianto
• Author: Nicolas Garrido
• Author: Divyanu Jain
• Author: Nazim Gherabi
• Author: Ioannis Sokolakis
• Author: Ayad Palani
• Author: Gokhan Calik
• Author: Deniz Kulaksiz
• Author: Vaida Simanaviciene
• Author: Mara Simopoulou
• Author: Nur Dokuzeylül Güngör
• Author: Gideon Blecher
• Author: Marco Falcone
• Author: Davor Ježek
• Author: Mirko Preto
• Author: Edouard Amar
• Author: Tan V. Le
• Author: Sun Tae Ahn
• Author: Andri Rezano
• Author: Keerti Singh
• Author: Lucia Rocco
• Author: Missy Savira
• Author: Osvaldo Rajmil
• Author: Sara Darbandi
• Author: Emrullah Sogutdelen
• Author: Luca Boeri
• Author: Guadalupe Hernández
• Author: Lukman Hakim
• Author: Yoshiharu Morimoto
• Author: Andrian Japari
• Author: Nikolaos Sofikitis
• Author: Baris Altay
• Author: Asli Metin Mahmutoglu
• Author: Manaf Al Hashimi
• Author: Imad Ziouziou
• Author: Christina Anagnostopoulou
• Author: Haocheng Lin
• Author: Rupin Shah
• Author's institution: University of Zagreb; School of Medicine; (Department of Histology and Embryology)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Basic Medical Sciences; Cytology, Histology and Embryology

Abstract (english)

Purpose: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice.

Materials and methods: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured.

Results: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%).

Conclusions: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial.

• Keywords (english): DNA fragmentation; Delphi method; Diagnostic test; Infertility/male; Survey
• Language: english
• Publication type: Professional paper - Professional paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: The World Journal of Men's Health
• Numbering: vol. 42, no. 1, pp. 202-215
• p-ISSN: 2287-4208
• e-ISSN: 2287-4690
• DOI: https://doi.org/10.5534/wjmh.230076
• URN:NBN: urn:nbn:hr:105:077110
• Publication: 2024-01
• Document URL: https://wjmh.org/DOIx.php?id=10.5534/wjmh.230076
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-08-19 08:11:35