Agarwal, Ashok, Farkouh, Ala’a, Saleh, Ramadan, Hamoda, Taha Abo-Almagd Abdel-Meguid, Salvio, Gianmaria, Boitrelle, Florence, Harraz, Ahmed M., Abou Ghayda, Ramy, Kavoussi, Parviz, Gül, Murat, and others. (2023) 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, 42 (1). ISSN 2287-4690. (doi:10.5534/wjmh.230076) (KAR id:102677)
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| Official URL: https://doi.org/10.5534/wjmh.230076 |
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Abstract
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.
| Item Type: | Article |
|---|---|
| DOI/Identification number: | 10.5534/wjmh.230076 |
| Uncontrolled keywords: | Delphi method; diagnostic test; DNA fragmentation; infertility, male; survey |
| Subjects: | Q Science |
| Divisions: | Divisions > Division of Natural Sciences > Biosciences |
| Funders: | University of Kent (https://ror.org/00xkeyj56) |
| SWORD Depositor: | JISC Publications Router |
| Depositing User: | JISC Publications Router |
| Date Deposited: | 18 Oct 2023 11:08 UTC |
| Last Modified: | 25 Mar 2024 12:32 UTC |
| Resource URI: | https://kar.kent.ac.uk/id/eprint/102677 (The current URI for this page, for reference purposes) |
University of Kent Author Information
Homa, Sheryl T..
| Creator's ORCID: |
 https://orcid.org/0000-0001-5027-0066
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