Global Andrology Forum Clinical Guidelines on the Relevance of Sperm DNA Fragmentation in Reproductive Medicine.
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Çayan Selahittin, Farkouh Ala'a, Agarwal Ashok, Atmoko Widi, Wyns Christine, Arafa Mohamed, Zini Armand, Shah Rupin, Alipour Hiva, Chung Eric, Saleh Ramadan, Pinggera Germar-Michael, Konstantinidis Charalampos, Al Hashimi Manaf, Pescatori Edoardo, Rambhatla Amarnath, Toprak Tuncay, Calogero Aldo E, Gül Murat, Park Hyun Jun, Altay Baris, Falcone Marco, Rashed Ayman, Le Tan V, Bahar Fahmi, Shatylko Taras, Görür Sadık, El-Sakka Ahmed I, Saylam Barış, Sarikaya Selcuk, Smith Ryan Patrick, Boeri Luca, Efesoy Ozan, Ceyhan Erman, Russo Giorgio Ivan, Ozer Cevahir, Ho Christopher Chee Kong, Gungor Nur Dokuzeylul, Özlü Deniz Noyan, Molina Juan Manuel Corral, Musa Muhammad Ujudud, Tsujimura Akira, Gokalp Fatih, Mohamed Mohamed Saeed, Okada Keisuke, Khalafalla Kareim, Kuroda Shinnosuke, Binsaleh Saleh, Motawi Ahmad Tarek, Shamohammadi Iman, Mogharabian Nasser, Manh Manh Truong, Taha Emad Abdelraheem, Makarounis Konstantinos, Mak Siu King, Shedeed Shedeed Ashour, Thomas Charalampos, Mostafa Taymour
Аннотация
MATERIALS AND METHODS: A multidisciplinary team of clinicians and reproductive experts from the Global Andrology Forum (GAF) reviewed the latest evidence on SDF, covering indications, testing methods, recurrent pregnancy loss, varicocele and its repair, assisted reproductive technologies (ART), treatment of associated conditions, antioxidant therapy, and sperm selection for ART. Expert statements and recommendations were developed and graded with the GRADE system using a modified Delphi process.
RESULTS: Based on the GAF surveys, systematic reviews, and meta-analyses related to SDF, 52 experts introduced and scored 24 statements and recommendations using the GRADE system. Of these, 87.5% (21/24) achieved strong ratings, reflecting broad consensus, while 12.5% (3/24) were rated weak. The guidelines provide evidence-based recommendations for clinical scenarios, including the role of SDF in infertility, recurrent pregnancy loss, and ART outcomes.
CONCLUSIONS: While there is growing interest and evidence regarding the clinical benefit of SDF testing and its utility in managing male infertility, significant gaps in the literature limit its routine use in clinical practice. The guidelines offer a structured framework for integrating SDF testing into male infertility management, emphasizing a tailored approach based on individual clinical scenarios. Clinicians must balance the benefits and limitations of SDF testing and antioxidant treatment to optimize care in reproductive medicine. These guidelines are critical for advancing evidence-based practices in male infertility management.