World J Mens Health.
2023 Jul;41(3):575-602. 10.5534/wjmh.220282.
Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
- Agarwal A
1,2
- Affiliations
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- 1Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA
- 2Cleveland Clinic Foundation, Cleveland, OH, USA
- 3Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- 4Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- 5Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
- 6Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- 7Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- 8Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
- 9Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
- 10Department of Urology, Hamad Medical Corporation, Doha, Qatar
- KMID: 2543305
- DOI: http://doi.org/10.5534/wjmh.220282
Abstract
- Purpose
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.
Materials and Methods
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.
Results
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.
Conclusions
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
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