Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Author:

Farkouh Ala’a1ORCID,Agarwal Ashok12ORCID,Hamoda Taha Abo-Almagd Abdel-Meguid34ORCID,Kavoussi Parviz5ORCID,Saleh Ramadan67ORCID,Zini Armand8ORCID,Arafa Mohamed91011ORCID,Harraz Ahmed M.121314ORCID,Gul Murat15ORCID,Karthikeyan Vilvapathy Senguttuvan16ORCID,Durairajanayagam Damayanthi17ORCID,Rambhatla Amarnath18ORCID,Boitrelle Florence1920ORCID,Chung Eric21ORCID,Birowo Ponco22ORCID,Toprak Tuncay23ORCID,Ghayda Ramy Abou24ORCID,Cannarella Rossella2526ORCID,Phuoc Nguyen Ho Vinh2728ORCID,Dimitriadis Fotios29ORCID,Russo Giorgio I.30ORCID,Sokolakis Ioannis29ORCID,Mostafa Taymour10ORCID,Makarounis Konstantinos31ORCID,Ziouziou Imad32ORCID,Kuroda Shinnosuke26ORCID,Bendayan Marion19ORCID,Kaiyal Raneen Sawaid26ORCID,Japari Andrian33ORCID,Simopoulou Mara34ORCID,Rocco Lucia35ORCID,Garrido Nicolas36ORCID,Gherabi Nazim37ORCID,Bocu Kadir38ORCID,Kahraman Oguzhan39ORCID,Le Tan V.2728ORCID,Wyns Christine40ORCID,Tremellen Kelton41ORCID,Sarikaya Selcuk42ORCID,Lewis Sheena43ORCID,Evenson Donald P.44ORCID,Ko Edmund45ORCID,Calogero Aldo E.25ORCID,Bahar Fahmi46ORCID,Martinez Marlon47ORCID,Crafa Andrea25ORCID,Nguyen Quang4849ORCID,Ambar Rafael F.5051ORCID,Colpi Giovanni52ORCID,Bakircioglu Mustafa Emre53ORCID,Henkel Ralf5455ORCID,Kandil Hussein56ORCID,Serefoglu Ege Can57ORCID,Alarbid Abdullah13ORCID,Tsujimura Akira58ORCID,Kheradmand Alireza59ORCID,Anagnostopoulou Christina60ORCID,Marino Angelo61ORCID,Adamyan Aram62ORCID,Zilaitiene Birute63ORCID,Ozer Cevahir39ORCID,Pescatori Edoardo64ORCID,Vogiatzi Paraskevi65ORCID,Busetto Gian Maria66ORCID,Balercia Giancarlo67ORCID,Elbardisi Haitham910ORCID,Akhavizadegan Hamed68ORCID,Sajadi Hesamoddin69ORCID,Taniguchi Hisanori70ORCID,Park Hyun Jun7172ORCID,Maldonado Rosas Israel73ORCID,Al-Marhoon Mohamed74ORCID,Gilani Mohammad Ali Sadighi69ORCID,Alhathal Naif75ORCID,Pinggera Germar-Michael76ORCID,Kothari Priyank77ORCID,Mogharabian Nasser78ORCID,Micic Sava79ORCID,Homa Sheryl80ORCID,Darbandi Sara8182ORCID,Long Tran Quang Tien83ORCID,Zohdy Wael10ORCID,Atmoko Widi22ORCID,Sabbaghian Marjan69ORCID,Ibrahim Wael84ORCID,Smith Ryan P.85ORCID,Ho Christopher Chee Kong86ORCID,de la Rosette Jean87ORCID,El-Sakka Ahmed I.88ORCID,Preto Mirko89ORCID,Zenoaga-Barbăroșie Cătălina90ORCID,Abumelha Saad Mohammed91ORCID,Baser Aykut92ORCID,Aydos Kaan93ORCID,Ramirez-Dominguez Liliana73ORCID,Kumar Vijay94ORCID,Ong Teng Aik95ORCID,Mierzwa Tiago Cesar96ORCID,Adriansjah Ricky97ORCID,Banihani Saleem A.98ORCID,Bowa Kasonde99ORCID,Fukuhara Shinichiro100ORCID,Peña Marcelo Rodriguez101ORCID,Moussa Mohamad102103ORCID,Ari Umut Çağın104ORCID,Cho Chak-Lam105ORCID,Tadros Nicholas N.106ORCID,Ugur Muhammet Rasit107ORCID,Amar Edouard108ORCID,Falcone Marco109ORCID,Santer Frederic Romain76ORCID,Kalkanli Arif110ORCID,Karna Keshab Kumar111ORCID,Khalafalla Kareim9112113ORCID,Vishwakarma Ranjit B.114ORCID,Finocchi Federica67ORCID,Giulioni Carlo115ORCID,Ceyhan Erman39ORCID,Çeker Gökhan116ORCID,Yazbeck Chadi117ORCID,Rajmil Osvaldo118ORCID,Yilmaz Mehmet119ORCID,Altay Baris120ORCID,Barrett Trenton L.121ORCID,Ngoo Kay Seong122ORCID,Roychoudhury Shubhadeep123ORCID,Salvio Gianmaria67ORCID,Lin Haocheng124ORCID,Kadioglu Ates125ORCID,Timpano Massimiliano109ORCID,Avidor-Reiss Tomer126127ORCID,Hakim Lukman128ORCID,Sindhwani Puneet128ORCID,Franco Giorgio129ORCID,Singh Rajender130ORCID,Giacone Filippo131ORCID,Ruzaev Mikhail132ORCID,Kosgi Raghavender133ORCID,Sofikitis Nikolaos134ORCID,Palani Ayad135ORCID,Calik Gokhan87ORCID,Kulaksız Deniz136ORCID,Jezek Davor137ORCID,Al Hashmi Manaf138139ORCID,Drakopoulos Panagiotis140141ORCID,Omran Huda142ORCID,Leonardi Sofia143ORCID,Celik-Ozenci Ciler144ORCID,Güngör Nur Dokuzeylül145ORCID,Ramsay Jonathan146ORCID,Amano Toshiyasu147ORCID,Sogutdelen Emrullah148ORCID,Duarsa Gede Wirya Kusuma149ORCID,Chiba Koji150ORCID,Jindal Sunil151ORCID,Savira Missy22ORCID,Boeri Luca152ORCID,Borges Edson153ORCID,Gupte Deepak154ORCID,Gokalp Fatih155ORCID,Hebrard Guadalupe Hernández73ORCID,Minhas Suks156ORCID,Shah Rupin114ORCID,

Affiliation:

1. Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA.

2. Cleveland Clinic Foundation, Cleveland, OH, USA.

3. Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.

4. Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt.

5. Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.

6. Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.

7. Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt.

8. Department of Surgery, McGill University, Montreal, QC, Canada.

9. Department of Urology, Hamad Medical Corporation, Doha, Qatar.

10. Department of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt.

11. Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.

12. Urology Department, Urology and Nephrology Center, Mansoura University, Mansura, Egypt.

13. Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait.

14. Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.

15. Department of Urology, Selçuk University School of Medicine, Konya, Turkey.

16. Andrology Unit, Department of Urology, Apollo Hospitals, Chennai, India.

17. Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.

18. Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA.

19. Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.

20. Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France.

21. Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.

22. Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

23. Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

24. Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.

25. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.

26. Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

27. Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.

28. Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.

29. Department of Urology, Aristotle University, School of Medicine, Thessaloniki, .

30. Urology Section, University of Catania, Catania, Italy.

31. Department of Urology and Andrology, Locus Medicus, Athens, Greece.

32. Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco.

33. Fertility Clinic, Telogorejo Hospital, Semarang, Indonesia.

34. Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

35. Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.

36. IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.

37. Department of Urology, University of Algiers, Algiers, Algeria.

38. Department of Urology, Silopi State Hospital, Sirnak, Turkey.

39. Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey.

40. Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

41. Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, South Australia, Australia.

42. Department of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

43. Examen Lab Ltd., Northern Ireland, UK.

44. SCSA Diagnostics, Brookings, SDUSA, USA.

45. Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.

46. Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia.

47. Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines.

48. Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam.

49. Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.

50. Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil.

51. Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil.

52. Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland.

53. SENSART Clinic, Urology, Fulya, Istanbul, Turkey.

54. Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.

55. Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.

56. Fakih IVF Fertility Center, Abu Dhabi, UAE.

57. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.

58. Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan.

59. Urology Department, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

60. Unit of Reproductive Medicine-EmbryoART, Leto Maternity Hospital, Athens, Greece.

61. ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy.

62. IVF Department, Astghik Medical Center, Yerevan, Armenia.

63. Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

64. Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy.

65. Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece.

66. Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy.

67. Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy.

68. Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

69. Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Teheran, Iran.

70. Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan.

71. Department of Urology, Pusan National University School of Medicine, Busan, Korea.

72. Medical Research Institute of Pusan National University Hospital, Busan, Korea.

73. IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico.

74. Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Sultanate of Oman.

75. King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

76. Department of Urology, Innsbruck Medical University, Innsbruck, Austria.

77. Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India.

78. Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.

79. Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia.

80. Department of Biosciences, University of Kent, Canterbury, UK.

81. Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.

82. Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran.

83. Department of Obstetrics and Gynecology, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.

84. Department of Obstetrics Gynaecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt.

85. Department of Urology, University of Virginia School of Medicine, Virginia, USA.

86. Department of Surgery, School of Medicine, Taylor’s University, Subang Jaya, Selangor, Malaysia.

87. Department of Urology, Istanbul Medipol University, Istanbul, Turkey.

88. Department of Urology, Suez Canal University, Ismailia, Egypt.

89. Department of Urology, University of Turin, Turin, Italy.

90. Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania.

91. Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

92. Department of Urology, Bandirma Onyedi Eylül University, Balikesir, Turkey.

93. Department of Urology, Ankara University, Ankara, Turkey.

94. Department of Microbiology, Kurukshetra University, Kurukshetra, India.

95. Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia.

96. Androlab, Fertility Clinic, Curitiba, PR, Brazil.

97. Department of Urology, Faculty of Medicine of Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia.

98. Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan.

99. Department of Urology, University of Lusaka, Lusaka, Zambia.

100. Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan.

101. Instituto de Ginecologia y Fertilidad (IFER), Buenos Aire, Argentina.

102. Department of Urology, Lebanese University, Beirut, Lebanon.

103. Department of Urology, Al Zahraa Hospital, UMC, Lebanon.

104. Department of Reproduction, Kafkas University, Kars, Turkey.

105. S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong.

106. Division of Urology, Southern Illinois University, Springfield, IL, USA.

107. IVF Michigan, Bloomfield Hills, MI, USA.

108. American Hospital of Paris, Paris, France.

109. Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy.

110. Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey.

111. Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA.

112. Urology Department, University of Texas McGovern Medical School, Houston, TX, USA.

113. Urology Department, MD Anderson Cancer Center, Houston, TX, USA.

114. Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.

115. Department of Urology, Polytechnic University of Marche Region, Ancona, Italy.

116. Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.

117. Obstetrics Gynecology and Reproductive Medicine, Reprogynes Medical Institute, Paris, France.

118. Department of Andrology, Fundacio Puigvert, Barcelona, Spain.

119. Asklepios Clinic Triberg, Urology, Freiburg, Germany.

120. Department of Urology, Ege University, Izmir, Turkey.

121. Perth Urology Clinic, Perth, WA, Australia.

122. Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia.

123. Department of Life Science and Bioinformatics, Assam University, Silchar, India.

124. Department of Urology, Peking University Third Hospital, Beijing, China.

125. Section of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey.

126. Department of Biological Sciences, University of Toledo, Toledo, OH, USA.

127. Department of Urology and Transplantation, University of Toledo, Toledo, OH, USA.

128. Department of Urology, Universitas Airlangga, Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.

129. Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.

130. Division of Endocrinology, Central Drug Research Institute, Lucknow, India.

131. Centro HERA, Unità di Medicina della Riproduzione, Sant’Agata Li Battiati, Catania, Italy.

132. Private Clinic, Moscow, Russia.

133. Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India.

134. Department of Urology, Ioannina University School of Medicine, Ioannina, Greece.

135. Research Centre, University of Garmian, Kalar, Iraq.

136. Department of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey.

137. Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University Hospital Zagreb, Zagreb, Croatia.

138. Department of Urology, Burjeel Hospital, Abu Dhabi, UAE.

139. Department of Urology, College of Medicine and Health Science, Khalifa University, Abu Dhabi, UAE.

140. Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.

141. IVF Athens, Athens, Greece.

142. Al Aljenan Medical Center, Pulse Health Training Center, Manama, Kingdom of Bahrain.

143. Central Laboratory, Hospital Público Materno Infantil de Salta, Salta, Argentina.

144. Department of Histology and Embryology, Faculty of Medicine, Koç University, Istanbul, Turkey.

145. Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey.

146. Department of Andrology, Hammersmith Hospital, London, UK.

147. Department of Urology, Nagano Red Cross Hospital, Nagano, Japan.

148. Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey.

149. Department of Urology, Udayana University, Denpasar, Indonesia.

150. Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.

151. Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India.

152. Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.

153. Fertility Assisted Fertilization Center, São Paulo, Brazil.

154. Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India.

155. Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey.

156. Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.

Publisher

XMLink

Subject

Pharmacology (medical),Urology,Psychiatry and Mental health,Public Health, Environmental and Occupational Health,Health Policy,Aging,Reproductive Medicine

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