Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
Ashok Agarwal
(1)
,
Ala’a Farkouh
(1)
,
Ramadan Saleh
(2)
,
Taha Abo-Almagd Abdel-Meguid Hamoda
(3, 4)
,
Ahmed M Harraz
(5)
,
Parviz Kavoussi
,
Mohamed Arafa
(6, 7)
,
Gianmaria Salvio
(8)
,
Amarnath Rambhatla
(9)
,
Tuncay Toprak
,
Murat Gül
(10)
,
Nguyen Ho Vinh Phuoc
,
Florence Boitrelle
(11, 12)
,
Ponco Birowo
(13)
,
Ramy Abou Ghayda
(14)
,
Rossella Cannarella
(15)
,
Shinnosuke Kuroda
(1)
,
Damayanthi Durairajanayagam
(16)
,
Armand Zini
(17)
,
Christine Wyns
(18)
,
Selcuk Sarikaya
(19)
,
Kelton Tremellen
(20)
,
Taymour Mostafa
(7)
,
Ioannis Sokolakis
(21)
,
Donald P Evenson
,
Ralf Henkel
(22, 23)
,
Wael Zohdy
(7)
,
Eric Chung
(24)
,
Imad Ziouziou
,
Marco Falcone
(25)
,
Giorgio I Russo
(15)
,
Manaf Al-Hashimi
(26, 27)
,
Aldo E Calogero
(15)
,
Edmund Ko
(28)
,
Giovanni Colpi
,
Sheena Lewis
,
Ege Can Serefoglu
,
Fahmi Bahar
(29)
,
Marlon Martinez
(30)
,
Quang Nguyen
(31)
,
Rafael F Ambar
,
Mustafa Emre Bakircioglu
,
Hussein Kandil
,
Nasser Mogharabian
(32)
,
Marjan Sabbaghian
(33)
,
Hisanori Taniguchi
(34)
,
Akira Tsujimura
,
Hesamoddin Sajadi
(33)
,
Wael Ibrahim
,
Widi Atmoko
(13)
,
Paraskevi Vogiatzi
,
Sezgin Gunes
(35)
,
Mohammad Ali Sadighi Gilani
(33)
,
Shubhadeep Roychoudhury
(36)
,
Nur Dokuzeylül Güngör
(37)
,
Lukman Hakim
(38)
,
Ricky Adriansjah
(39)
,
Priyank Kothari
,
Sunil Jindal
,
Edouard Amar
(40)
,
Hyun Jun Park
(41)
,
Tran Quang Tien Long
,
Sheryl Homa
(42)
,
Birute Zilaitiene
(43)
,
Israel Maldonado Rosas
,
Angelo Marino
,
Edoardo Pescatori
,
Cevahir Ozer
(44)
,
Hamed Akhavizadegan
(45)
,
Nicolas Garrido
,
Gian Maria Busetto
(46)
,
Aram Adamyan
,
Mohamed Al-Marhoon
(47)
,
Haitham Elbardisi
(48, 49)
,
Parisa Dolati
(50)
,
Mahsa Darbandi
,
Sara Darbandi
,
Giancarlo Balercia
(8)
,
Germar-Michael Pinggera
(51)
,
Sava Micic
,
Christopher Chee Kong Ho
(52)
,
Mohamad Moussa
(53)
,
Mirko Preto
(54)
,
Cătălina Zenoaga-Barbăroşie
(55)
,
Ryan P Smith
(56)
,
Raghavender Kosgi
,
Jean de La Rosette
(57)
,
Ahmed I El-Sakka
,
Saad Mohammed Abumelha
(3)
,
Tiago Cesar Mierzwa
,
Teng Aik Ong
(58)
,
Saleem A Banihani
(59)
,
Kasonde Bowa
(60)
,
Shinichiro Fukuhara
(61)
,
Luca Boeri
,
Yavuz Onur Danacıoğlu
,
Fatih Gokalp
(62)
,
Osama Mohamed Selim
(63)
,
Chak-Lam Cho
(64)
,
Nicholas N Tadros
,
Muhammet Rasit Ugur
,
Mehmet Serkan Ozkent
,
Peter Chiu
(64)
,
Arif Kalkanli
,
Kareim Khalafalla
(48, 65)
,
Ranjit B Vishwakarma
(66)
,
Federica Finocchi
(8)
,
Sotiris Andreadakis
,
Carlo Giulioni
(8)
,
Gökhan Çeker
,
Erman Ceyhan
(44)
,
Vineet Malhotra
,
Mehmet Yilmaz
(67)
,
Massimiliano Timpano
(54)
,
Trenton L Barrett
,
Shannon Hee Kyung Kim
(68)
,
Sun-Tae Ahn
,
Filippo Giacone
,
Ayad Palani
(69)
,
Gede Wirya Kusuma Duarsa
(70)
,
Ates Kadioglu
(71)
,
Franco Gadda
,
Daniel Suslik Zylbersztejn
,
Kaan Aydos
(72)
,
Deniz Kulaksız
,
Deepak Gupte
,
Gokhan Calik
(57)
,
Keshab Kumar Karna
,
Panagiotis Drakopoulos
(73)
,
Aykut Baser
,
Vijay Kumar
(74)
,
Juan Manuel Corral Molina
(75)
,
Osvaldo Rajmil
(76)
,
Raphael H Ferreira
,
Sofia Leonardi
,
Armen Avoyan
,
Emrullah Sogutdelen
(77)
,
Giorgio Franco
(78)
,
Jonathan Ramsay
(79)
,
Liliana Ramirez
,
Rupin Shah
,
Vilvapathy Senguttuvan Karthikeyan
(66)
1
Cleveland Clinic
2 Sohag University
3 King Abdulaziz University
4 Minia University
5 Mansoura University [Egypt]
6 Weill Cornell Medical College-Qatar, Qatar
7 Cairo University
8 UNIVPM - Polytechnic University of Marche [Ancona, Italy] / Università Politecnica delle Marche [Ancona, Italia]
9 Vattikuti Urology Institute
10 Faculty of Medicine [Selcuk University Konya, Turkey]
11 CHI Poissy-Saint-Germain
12 BREED - Biologie de la Reproduction, Environnement, Epigénétique & Développement
13 Cipto Mangunkusumo Hospital [Jakarta]
14 Case Western Reserve University, Cleveland
15 Unict - Università degli studi di Catania = University of Catania
16 UiTM - Universiti Teknologi MARA [Shah Alam]
17 McGill University = Université McGill [Montréal, Canada]
18 Cliniques Universitaires Saint-Luc [Bruxelles]
19 Gulhane Training and Research Hospital
20 Flinders University of South Australia
21 Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.
22 Imperial College London
23 UWC - University of the Western Cape
24 Princess Alexandra Hospital, Brisbane
25 Molinette Hospital
26 Burjeel Hospital
27 Khalifa University
28 Loma Linda University
29 Biruni University
30 University of Santo Tomas [Manila, Philippines]
31 VNU - Vietnam National University [Hanoï]
32 Shahroud University of Medical Sciences
33 Royan Institute for Reproductive Biomedicine [Tehran, Iran]
34 Kansai University
35 OMU - Ondokuz Mayis University
36 Assam University
37 Bahcesehir University [Istanbul]
38 UNAIR - Universitas Airlangga
39 UnPad - Universitas Padjadjaran = Padjadjaran University
40 Hôpital Américain de Paris
41 PNU - Pusan National University
42 University of Kent [Canterbury]
43 LSMU - Lithuanian University of health Sciences
44 Başkent University Hospital [Adana, Turkey]
45 TUMS - Tehran University of Medical Sciences
46 Unifg - Università degli Studi di Foggia = University of Foggia
47 SQU - Sultan Qaboos University
48 Hamad Medical Corporation [Doha, Qatar]
49 Weill Cornell Medicine [Qatar]
50 Shiraz University - Shiraz University
51 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
52 Taylor’s University
53 LU / ULB - الجامعة اللبنانية [بيروت] = Lebanese University [Beirut] = Université libanaise [Beyrouth]
54 Molinette Hospital
55 UniBuc - University of Bucharest
56 University of Virginia
57 Istanbul Medipol University
58 UM - University of Malaya = Universiti Malaya [Kuala Lumpur, Malaisie]
59 JUST - Jordan University of Science and Technology [Irbid, Jordan]
60 UNZA - University of Zambia [Lusaka]
61 Osaka University [Osaka]
62 Hatay Mustafa Kemal University
63 Cairo University - Faculty of Medicine
64 CUHK - The Chinese University of Hong Kong [Hong Kong]
65 UIC - University of Illinois [Chicago]
66 Lilavati Hospital and Research Centre
67 Uniklinik - Universitäts Klinikum Freiburg = University Medical Center Freiburg
68 Macquarie University [Sydney]
69 University of Garmian
70 Udayana University [Bali]
71 Istanbul University
72 Ankara Üniversitesi
73 UZ Brussel - Universitair Ziekenhuis Brussel = University Hospital of Brussels
74 Kurukshetra University
75 Clinic Barcelona Hospital Universitari
76 Fundació Puigvert [Barcelona, Spain]
77 Abant Izzet Baysal University - Bolu Abant İzzet Baysal Üniversitesi
78 UNIROMA - Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
79 Hammersmith Hospital NHS Imperial College Healthcare
2 Sohag University
3 King Abdulaziz University
4 Minia University
5 Mansoura University [Egypt]
6 Weill Cornell Medical College-Qatar, Qatar
7 Cairo University
8 UNIVPM - Polytechnic University of Marche [Ancona, Italy] / Università Politecnica delle Marche [Ancona, Italia]
9 Vattikuti Urology Institute
10 Faculty of Medicine [Selcuk University Konya, Turkey]
11 CHI Poissy-Saint-Germain
12 BREED - Biologie de la Reproduction, Environnement, Epigénétique & Développement
13 Cipto Mangunkusumo Hospital [Jakarta]
14 Case Western Reserve University, Cleveland
15 Unict - Università degli studi di Catania = University of Catania
16 UiTM - Universiti Teknologi MARA [Shah Alam]
17 McGill University = Université McGill [Montréal, Canada]
18 Cliniques Universitaires Saint-Luc [Bruxelles]
19 Gulhane Training and Research Hospital
20 Flinders University of South Australia
21 Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.
22 Imperial College London
23 UWC - University of the Western Cape
24 Princess Alexandra Hospital, Brisbane
25 Molinette Hospital
26 Burjeel Hospital
27 Khalifa University
28 Loma Linda University
29 Biruni University
30 University of Santo Tomas [Manila, Philippines]
31 VNU - Vietnam National University [Hanoï]
32 Shahroud University of Medical Sciences
33 Royan Institute for Reproductive Biomedicine [Tehran, Iran]
34 Kansai University
35 OMU - Ondokuz Mayis University
36 Assam University
37 Bahcesehir University [Istanbul]
38 UNAIR - Universitas Airlangga
39 UnPad - Universitas Padjadjaran = Padjadjaran University
40 Hôpital Américain de Paris
41 PNU - Pusan National University
42 University of Kent [Canterbury]
43 LSMU - Lithuanian University of health Sciences
44 Başkent University Hospital [Adana, Turkey]
45 TUMS - Tehran University of Medical Sciences
46 Unifg - Università degli Studi di Foggia = University of Foggia
47 SQU - Sultan Qaboos University
48 Hamad Medical Corporation [Doha, Qatar]
49 Weill Cornell Medicine [Qatar]
50 Shiraz University - Shiraz University
51 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
52 Taylor’s University
53 LU / ULB - الجامعة اللبنانية [بيروت] = Lebanese University [Beirut] = Université libanaise [Beyrouth]
54 Molinette Hospital
55 UniBuc - University of Bucharest
56 University of Virginia
57 Istanbul Medipol University
58 UM - University of Malaya = Universiti Malaya [Kuala Lumpur, Malaisie]
59 JUST - Jordan University of Science and Technology [Irbid, Jordan]
60 UNZA - University of Zambia [Lusaka]
61 Osaka University [Osaka]
62 Hatay Mustafa Kemal University
63 Cairo University - Faculty of Medicine
64 CUHK - The Chinese University of Hong Kong [Hong Kong]
65 UIC - University of Illinois [Chicago]
66 Lilavati Hospital and Research Centre
67 Uniklinik - Universitäts Klinikum Freiburg = University Medical Center Freiburg
68 Macquarie University [Sydney]
69 University of Garmian
70 Udayana University [Bali]
71 Istanbul University
72 Ankara Üniversitesi
73 UZ Brussel - Universitair Ziekenhuis Brussel = University Hospital of Brussels
74 Kurukshetra University
75 Clinic Barcelona Hospital Universitari
76 Fundació Puigvert [Barcelona, Spain]
77 Abant Izzet Baysal University - Bolu Abant İzzet Baysal Üniversitesi
78 UNIROMA - Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
79 Hammersmith Hospital NHS Imperial College Healthcare
Ashok Agarwal
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- Function : Correspondent author
- PersonId : 770805
- ORCID : 0000-0003-0585-1026
- IdRef : 181655853
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Taha Abo-Almagd Abdel-Meguid Hamoda
- Function : Author
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Ahmed M Harraz
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Parviz Kavoussi
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Mohamed Arafa
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Gianmaria Salvio
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Amarnath Rambhatla
- Function : Author
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Tuncay Toprak
- Function : Author
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Murat Gül
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Nguyen Ho Vinh Phuoc
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Florence Boitrelle
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Ponco Birowo
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Ramy Abou Ghayda
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Rossella Cannarella
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Damayanthi Durairajanayagam
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Armand Zini
- Function : Author
- PersonId : 807968
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Christine Wyns
- Function : Author
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Selcuk Sarikaya
- Function : Author
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Kelton Tremellen
- Function : Author
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Ioannis Sokolakis
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Donald P Evenson
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Ralf Henkel
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Eric Chung
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Imad Ziouziou
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Giorgio I Russo
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Manaf Al-Hashimi
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Aldo E Calogero
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Giovanni Colpi
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Sheena Lewis
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Ege Can Serefoglu
- Function : Author
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Marlon Martinez
- Function : Author
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Quang Nguyen
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Rafael F Ambar
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Mustafa Emre Bakircioglu
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Hussein Kandil
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Nasser Mogharabian
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Marjan Sabbaghian
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Hisanori Taniguchi
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Akira Tsujimura
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Hesamoddin Sajadi
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Wael Ibrahim
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Widi Atmoko
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Paraskevi Vogiatzi
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Sezgin Gunes
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Mohammad Ali Sadighi Gilani
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Shubhadeep Roychoudhury
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Nur Dokuzeylül Güngör
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Ricky Adriansjah
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Priyank Kothari
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Sunil Jindal
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Edouard Amar
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Hyun Jun Park
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Tran Quang Tien Long
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Sheryl Homa
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Birute Zilaitiene
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Israel Maldonado Rosas
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Angelo Marino
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Edoardo Pescatori
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Cevahir Ozer
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Hamed Akhavizadegan
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Nicolas Garrido
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Gian Maria Busetto
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Aram Adamyan
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Mohamed Al-Marhoon
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Haitham Elbardisi
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Mahsa Darbandi
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Sara Darbandi
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Giancarlo Balercia
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Germar-Michael Pinggera
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Sava Micic
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Christopher Chee Kong Ho
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Mohamad Moussa
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Cătălina Zenoaga-Barbăroşie
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Ryan P Smith
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Ahmed I El-Sakka
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Saad Mohammed Abumelha
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Tiago Cesar Mierzwa
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Teng Aik Ong
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Saleem A Banihani
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Kasonde Bowa
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Luca Boeri
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Yavuz Onur Danacıoğlu
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Fatih Gokalp
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Osama Mohamed Selim
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Chak-Lam Cho
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Nicholas N Tadros
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Muhammet Rasit Ugur
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Mehmet Serkan Ozkent
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Peter Chiu
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Kareim Khalafalla
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Ranjit B Vishwakarma
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Federica Finocchi
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Sotiris Andreadakis
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Carlo Giulioni
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Gökhan Çeker
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Erman Ceyhan
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Vineet Malhotra
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Mehmet Yilmaz
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Massimiliano Timpano
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Trenton L Barrett
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Shannon Hee Kyung Kim
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Sun-Tae Ahn
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Filippo Giacone
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Gede Wirya Kusuma Duarsa
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Franco Gadda
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Daniel Suslik Zylbersztejn
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Deniz Kulaksız
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Deepak Gupte
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Gokhan Calik
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Keshab Kumar Karna
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Panagiotis Drakopoulos
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Aykut Baser
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Juan Manuel Corral Molina
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Osvaldo Rajmil
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Raphael H Ferreira
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Sofia Leonardi
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Armen Avoyan
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Emrullah Sogutdelen
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Giorgio Franco
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Jonathan Ramsay
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Liliana Ramirez
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Rupin Shah
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Vilvapathy Senguttuvan Karthikeyan
- Function : Author
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Abstract
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.
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.
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.
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 guideline recommendations. Expert recommendations are proposed to help guide clinicians.
Origin | Files produced by the author(s) |
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