doi: 10.5534/wjmh.250005.
Online ahead of print.
Global Andrology Forum Clinical Guidelines on the Relevance of Sperm DNA Fragmentation in Reproductive Medicine
Selahittin Çayan
1
2
, Ala'a Farkouh
2
3
, Ashok Agarwal
2
4
, Widi Atmoko
2
5
, Christine Wyns
2
6
7
, Mohamed Arafa
2
8
9
10
, Armand Zini
2
11
, Rupin Shah
2
12
, Hiva Alipour
2
13
, Eric Chung
2
14
, Ramadan Saleh
2
15
16
, Germar-Michael Pinggera
2
17
, Charalampos Konstantinidis
2
18
, Manaf Al Hashimi
2
19
20
, Edoardo Pescatori
2
21
, Amarnath Rambhatla
2
22
23
, Tuncay Toprak
2
24
, Aldo E Calogero
2
25
, Murat Gül
2
26
27
, Hyun Jun Park
2
28
29
, Baris Altay
2
30
, Marco Falcone
2
31
32
, Ayman Rashed
2
33
, Tan V Le
2
34
35
, Fahmi Bahar
2
36
37
, Taras Shatylko
2
38
, Sadık Görür
2
39
, Ahmed I El-Sakka
2
40
, Barış Saylam
2
41
, Selcuk Sarikaya
2
42
, Ryan Patrick Smith
2
43
, Luca Boeri
2
44
, Ozan Efesoy
2
41
, Erman Ceyhan
2
45
, Giorgio Ivan Russo
2
46
, Cevahir Ozer
2
47
, Christopher Chee Kong Ho
2
48
, Nur Dokuzeylul Gungor
2
49
50
, Deniz Noyan Özlü
2
51
, Juan Manuel Corral Molina
2
52
, Muhammad Ujudud Musa
2
53
54
, Akira Tsujimura
2
55
, Fatih Gokalp
2
39
, Mohamed Saeed Mohamed
2
56
, Keisuke Okada
2
57
, Kareim Khalafalla
2
9
58
, Shinnosuke Kuroda
2
59
, Saleh Binsaleh
2
60
, Ahmad Tarek Motawi
2
19
, Iman Shamohammadi
2
61
, Nasser Mogharabian
2
62
, Manh Truong Manh
2
63
64
65
, Emad Abdelraheem Taha
2
66
67
, Konstantinos Makarounis
2
68
, Siu King Mak
2
69
, Shedeed Ashour Shedeed
2
19
70
, Charalampos Thomas
2
71
, Taymour Mostafa
2
8
Affiliations
Affiliations
- 1 Department of Urology, University of Mersin School of Medicine, Mersin, Türkiye.
- 2 Global Andrology Forum, Global Andrology Foundation, Moreland Hills, OH, USA.
- 3 Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
- 4 Cleveland Clinic, Cleveland, OH, USA. agarwaa32099@outlook.com.
- 5 Department of Urology, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
- 6 Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- 7 Institut de Recherche Experimentale, Pôle REPR, Université Catholique de Louvain, Brussels, Belgium.
- 8 Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.
- 9 Department of Urology, Hamad Medical Corporation, Doha, Qatar.
- 10 Urology Department, Weill Cornell Medicine Qatar, Doha, Qatar.
- 11 Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
- 12 Department of Urology, Lilavati Hospital & Research Centre, Mumbai, India.
- 13 Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
- 14 Department of Urology, University of Queensland/Princess Alexandra Hospital, Brisbane, Australia.
- 15 Department of Dermatology, Venereology and Andrology, Sohag University, Sohag, Egypt.
- 16 Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt.
- 17 Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
- 18 Urology & Neurourology Unit, National Rehabilitation Center, Athens, Greece.
- 19 Department of Urology, Burjeel Hospital, Abu Dhabi, UAE.
- 20 Department of Clinical Urology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE.
- 21 Andrology and Reproductive Medicine Unit, Next Fertility GynePro, Bologna, Italy.
- 22 Department of Urology, Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA.
- 23 Michigan State University College of Human Medicine, East Lansing, MI, USA.
- 24 Department of Urology, FSM Health Practice & Research Center, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Türkiye.
- 25 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- 26 Department of Urology, Selcuk University, Konya, Türkiye.
- 27 Department of Andrology, Selcuk University, Konya, Türkiye.
- 28 Department of Urology, Pusan National University School of Medicine, Busan, Korea.
- 29 Medical Research Institute, Pusan National University Hospital, Busan, Korea.
- 30 Departmant of Urology, Ege University, Izmir, Türkiye.
- 31 SSD Neurourologia and SCU Urologia - Cittá della Salute e della Scienza, Torino University, Torino, Italy.
- 32 Department of Urology, Biruni University, Istanbul, Türkiye.
- 33 Department of Urology & Andrology, October 6th University, Cairo, Egypt.
- 34 Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.
- 35 Department of Andrology and Nephro-Urology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
- 36 Andrology Section, Faculty of Medicine, Muhammadiyah Palembang University, Palembang, Indonesia.
- 37 Andrology Section, Siloam Sriwijaya Palembang Hospital, Palembang, Indonesia.
- 38 Andrology and Urology Department, V.I. Kulakov National Medical Research Center, Moscow, Russia.
- 39 Departmant of Urology, Hatay Mustafa Kemal University, Hatay, Türkiye.
- 40 Department of Urology, Suez Canal University, Ismailia, Egypt.
- 41 Department of Urology, University of Health Sciences, Mersin, Türkiye.
- 42 Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Türkiye.
- 43 Department of Urology, University of Virginia, Charlottesville, VA, USA.
- 44 Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- 45 Department of Urology, Baskent University Faculty of Medicine, Ankara, Türkiye.
- 46 Urology Section, University of Catania, Catania, Italy.
- 47 Department of Urology, Baskent University Faculty of Medicine, Adana, Türkiye.
- 48 Department of Surgery, Taylor's University, Kuala Lumpur, Malaysia.
- 49 Department of Obstetrics and Gynecology, Bahcesehir University, Istanbul, Türkiye.
- 50 IVF Unit, Bahceci Health Group, Istanbul, Türkiye.
- 51 Urology Unit, University of Medical Sciences Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Türkiye.
- 52 Department of Urology, Hospital Clinic Barcelona, Barcelona, Spain.
- 53 Urology Unit, Department of Surgery, Federal Teaching Hospital Katsina, Katsina, Nigeria.
- 54 Urology Unit, Department of Surgery, Al-Mithnab General Hospital Qassim Region, Al-Mithnab, Saudi Arabia.
- 55 Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Japan.
- 56 Dermatology, Venereology and Andrology Department, Al Azhar University, Cairo, Egypt.
- 57 Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
- 58 Department of Urology, College of Medicine, Qatar University, Doha, Qatar.
- 59 Department of Urology, Center for Reproductive Medicine, Yokohama City University Medical Center, Yokohama, Japan.
- 60 Department of Surgery, Section of Urology, King Saud University, Riyadh, Saudi Arabia.
- 61 Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.
- 62 Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
- 63 Fertility Centre, Hanh Phuc International Hospital, Binh Duong, Vietnam.
- 64 Department of Urology, Ho Chi Minh City Medicine and Pharmacy University, Binh Duong, Vietnam.
- 65 Men's Health Centre, Ho Chi Minh City, Vietnam.
- 66 Department of Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
- 67 Department of Dermatology and Venereology, Assiut University, Assiut, Egypt.
- 68 Department of Urology and Andrology, Locus Medicus, Athens, Greece.
- 69 Department of Surgery, Union Hospital, Hong Kong, Hong Kong.
- 70 Andrology Department, Dr Erfan & Bagedo General Hospital, Jeddah, Saudi Arabia.
- 71 Department of Urology, General Hospital, Corinth, Greece.
- PMID: 40263962
- DOI: 10.5534/wjmh.250005
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Global Andrology Forum Clinical Guidelines on the Relevance of Sperm DNA Fragmentation in Reproductive Medicine
Selahittin Çayan et al.
World J Mens Health.
.
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doi: 10.5534/wjmh.250005.
Online ahead of print.
Authors
Selahittin Çayan
1
2
, Ala'a Farkouh
2
3
, Ashok Agarwal
2
4
, Widi Atmoko
2
5
, Christine Wyns
2
6
7
, Mohamed Arafa
2
8
9
10
, Armand Zini
2
11
, Rupin Shah
2
12
, Hiva Alipour
2
13
, Eric Chung
2
14
, Ramadan Saleh
2
15
16
, Germar-Michael Pinggera
2
17
, Charalampos Konstantinidis
2
18
, Manaf Al Hashimi
2
19
20
, Edoardo Pescatori
2
21
, Amarnath Rambhatla
2
22
23
, Tuncay Toprak
2
24
, Aldo E Calogero
2
25
, Murat Gül
2
26
27
, Hyun Jun Park
2
28
29
, Baris Altay
2
30
, Marco Falcone
2
31
32
, Ayman Rashed
2
33
, Tan V Le
2
34
35
, Fahmi Bahar
2
36
37
, Taras Shatylko
2
38
, Sadık Görür
2
39
, Ahmed I El-Sakka
2
40
, Barış Saylam
2
41
, Selcuk Sarikaya
2
42
, Ryan Patrick Smith
2
43
, Luca Boeri
2
44
, Ozan Efesoy
2
41
, Erman Ceyhan
2
45
, Giorgio Ivan Russo
2
46
, Cevahir Ozer
2
47
, Christopher Chee Kong Ho
2
48
, Nur Dokuzeylul Gungor
2
49
50
, Deniz Noyan Özlü
2
51
, Juan Manuel Corral Molina
2
52
, Muhammad Ujudud Musa
2
53
54
, Akira Tsujimura
2
55
, Fatih Gokalp
2
39
, Mohamed Saeed Mohamed
2
56
, Keisuke Okada
2
57
, Kareim Khalafalla
2
9
58
, Shinnosuke Kuroda
2
59
, Saleh Binsaleh
2
60
, Ahmad Tarek Motawi
2
19
, Iman Shamohammadi
2
61
, Nasser Mogharabian
2
62
, Manh Truong Manh
2
63
64
65
, Emad Abdelraheem Taha
2
66
67
, Konstantinos Makarounis
2
68
, Siu King Mak
2
69
, Shedeed Ashour Shedeed
2
19
70
, Charalampos Thomas
2
71
, Taymour Mostafa
2
8
Affiliations
- 1 Department of Urology, University of Mersin School of Medicine, Mersin, Türkiye.
- 2 Global Andrology Forum, Global Andrology Foundation, Moreland Hills, OH, USA.
- 3 Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
- 4 Cleveland Clinic, Cleveland, OH, USA. agarwaa32099@outlook.com.
- 5 Department of Urology, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
- 6 Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- 7 Institut de Recherche Experimentale, Pôle REPR, Université Catholique de Louvain, Brussels, Belgium.
- 8 Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.
- 9 Department of Urology, Hamad Medical Corporation, Doha, Qatar.
- 10 Urology Department, Weill Cornell Medicine Qatar, Doha, Qatar.
- 11 Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
- 12 Department of Urology, Lilavati Hospital & Research Centre, Mumbai, India.
- 13 Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
- 14 Department of Urology, University of Queensland/Princess Alexandra Hospital, Brisbane, Australia.
- 15 Department of Dermatology, Venereology and Andrology, Sohag University, Sohag, Egypt.
- 16 Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt.
- 17 Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
- 18 Urology & Neurourology Unit, National Rehabilitation Center, Athens, Greece.
- 19 Department of Urology, Burjeel Hospital, Abu Dhabi, UAE.
- 20 Department of Clinical Urology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE.
- 21 Andrology and Reproductive Medicine Unit, Next Fertility GynePro, Bologna, Italy.
- 22 Department of Urology, Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA.
- 23 Michigan State University College of Human Medicine, East Lansing, MI, USA.
- 24 Department of Urology, FSM Health Practice & Research Center, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Türkiye.
- 25 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- 26 Department of Urology, Selcuk University, Konya, Türkiye.
- 27 Department of Andrology, Selcuk University, Konya, Türkiye.
- 28 Department of Urology, Pusan National University School of Medicine, Busan, Korea.
- 29 Medical Research Institute, Pusan National University Hospital, Busan, Korea.
- 30 Departmant of Urology, Ege University, Izmir, Türkiye.
- 31 SSD Neurourologia and SCU Urologia - Cittá della Salute e della Scienza, Torino University, Torino, Italy.
- 32 Department of Urology, Biruni University, Istanbul, Türkiye.
- 33 Department of Urology & Andrology, October 6th University, Cairo, Egypt.
- 34 Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.
- 35 Department of Andrology and Nephro-Urology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
- 36 Andrology Section, Faculty of Medicine, Muhammadiyah Palembang University, Palembang, Indonesia.
- 37 Andrology Section, Siloam Sriwijaya Palembang Hospital, Palembang, Indonesia.
- 38 Andrology and Urology Department, V.I. Kulakov National Medical Research Center, Moscow, Russia.
- 39 Departmant of Urology, Hatay Mustafa Kemal University, Hatay, Türkiye.
- 40 Department of Urology, Suez Canal University, Ismailia, Egypt.
- 41 Department of Urology, University of Health Sciences, Mersin, Türkiye.
- 42 Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Türkiye.
- 43 Department of Urology, University of Virginia, Charlottesville, VA, USA.
- 44 Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- 45 Department of Urology, Baskent University Faculty of Medicine, Ankara, Türkiye.
- 46 Urology Section, University of Catania, Catania, Italy.
- 47 Department of Urology, Baskent University Faculty of Medicine, Adana, Türkiye.
- 48 Department of Surgery, Taylor's University, Kuala Lumpur, Malaysia.
- 49 Department of Obstetrics and Gynecology, Bahcesehir University, Istanbul, Türkiye.
- 50 IVF Unit, Bahceci Health Group, Istanbul, Türkiye.
- 51 Urology Unit, University of Medical Sciences Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Türkiye.
- 52 Department of Urology, Hospital Clinic Barcelona, Barcelona, Spain.
- 53 Urology Unit, Department of Surgery, Federal Teaching Hospital Katsina, Katsina, Nigeria.
- 54 Urology Unit, Department of Surgery, Al-Mithnab General Hospital Qassim Region, Al-Mithnab, Saudi Arabia.
- 55 Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Japan.
- 56 Dermatology, Venereology and Andrology Department, Al Azhar University, Cairo, Egypt.
- 57 Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
- 58 Department of Urology, College of Medicine, Qatar University, Doha, Qatar.
- 59 Department of Urology, Center for Reproductive Medicine, Yokohama City University Medical Center, Yokohama, Japan.
- 60 Department of Surgery, Section of Urology, King Saud University, Riyadh, Saudi Arabia.
- 61 Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.
- 62 Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
- 63 Fertility Centre, Hanh Phuc International Hospital, Binh Duong, Vietnam.
- 64 Department of Urology, Ho Chi Minh City Medicine and Pharmacy University, Binh Duong, Vietnam.
- 65 Men's Health Centre, Ho Chi Minh City, Vietnam.
- 66 Department of Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
- 67 Department of Dermatology and Venereology, Assiut University, Assiut, Egypt.
- 68 Department of Urology and Andrology, Locus Medicus, Athens, Greece.
- 69 Department of Surgery, Union Hospital, Hong Kong, Hong Kong.
- 70 Andrology Department, Dr Erfan & Bagedo General Hospital, Jeddah, Saudi Arabia.
- 71 Department of Urology, General Hospital, Corinth, Greece.
- PMID: 40263962
- DOI: 10.5534/wjmh.250005
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Abstract
Purpose: To evaluate the evidence on sperm DNA fragmentation (SDF) and its clinical applications in reproductive medicine, highlighting benefits, limitations, and guidelines for its use to assist clinicians in objective decision-making.
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.
Keywords: DNA fragmentation; Infertility, male; Practice guideline; Reproductive medicine; Spermatozoa.
Copyright © 2025 Korean Society for Sexual Medicine and Andrology.
Conflict of interest statement
The authors have nothing to disclose.
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