男性不育症中精子DNA碎片化升高管理的争议与共识：一项全球调查、现行指南及专家建议
Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
作者信息
Farkouh Ala'a, Agarwal Ashok, Hamoda Taha Abo-Almagd Abdel-Meguid, Kavoussi Parviz, Saleh Ramadan, Zini Armand, Arafa Mohamed, Harraz Ahmed M, Gul Murat, Karthikeyan Vilvapathy Senguttuvan, Durairajanayagam Damayanthi, Rambhatla Amarnath, Boitrelle Florence, Chung Eric, Birowo Ponco, Toprak Tuncay, Ghayda Ramy Abou, Cannarella Rossella, Phuoc Nguyen Ho Vinh, Dimitriadis Fotios, Russo Giorgio I, Sokolakis Ioannis, Mostafa Taymour, Makarounis Konstantinos, Ziouziou Imad, Kuroda Shinnosuke, Bendayan Marion, Kaiyal Raneen Sawaid, Japari Andrian, Simopoulou Mara, Rocco Lucia, Garrido Nicolas, Gherabi Nazim, Bocu Kadir, Kahraman Oguzhan, Le Tan V, Wyns Christine, Tremellen Kelton, Sarikaya Selcuk, Lewis Sheena, Evenson Donald P, Ko Edmund, Calogero Aldo E, Bahar Fahmi, Martinez Marlon, Crafa Andrea, Nguyen Quang, Ambar Rafael F, Colpi Giovanni, Bakircioglu Mustafa Emre, Henkel Ralf, Kandil Hussein, Serefoglu Ege Can, Alarbid Abdullah, Tsujimura Akira, Kheradmand Alireza, Anagnostopoulou Christina, Marino Angelo, Adamyan Aram, Zilaitiene Birute, Ozer Cevahir, Pescatori Edoardo, Vogiatzi Paraskevi, Busetto Gian Maria, Balercia Giancarlo, Elbardisi Haitham, Akhavizadegan Hamed, Sajadi Hesamoddin, Taniguchi Hisanori, Park Hyun Jun, Maldonado Rosas Israel, Al-Marhoon Mohamed, Sadighi Gilani Mohammad Ali, Alhathal Naif, Pinggera Germar-Michael, Kothari Priyank, Mogharabian Nasser, Micic Sava, Homa Sheryl, Darbandi Sara, Long Tran Quang Tien, Zohdy Wael, Atmoko Widi, Sabbaghian Marjan, Ibrahim Wael, Smith Ryan P, Ho Christopher Chee Kong, de la Rosette Jean, El-Sakka Ahmed I, Preto Mirko, Zenoaga-Barbăroșie Cătălina, Abumelha Saad Mohammed, Baser Aykut, Aydos Kaan, Ramirez-Dominguez Liliana, Kumar Vijay, Ong Teng Aik, Mierzwa Tiago Cesar, Adriansjah Ricky, Banihani Saleem A, Bowa Kasonde, Fukuhara Shinichiro, Rodriguez Peña Marcelo, Moussa Mohamad, Ari Umut Çağın, Cho Chak-Lam, Tadros Nicholas N, Ugur Muhammet Rasit, Amar Edouard, Falcone Marco, Santer Frederic Romain, Kalkanli Arif, Karna Keshab Kumar, Khalafalla Kareim, Vishwakarma Ranjit B, Finocchi Federica, Giulioni Carlo, Ceyhan Erman, Çeker Gökhan, Yazbeck Chadi, Rajmil Osvaldo, Yilmaz Mehmet, Altay Baris, Barrett Trenton L, Ngoo Kay Seong, Roychoudhury Shubhadeep, Salvio Gianmaria, Lin Haocheng, Kadioglu Ates, Timpano Massimiliano, Avidor-Reiss Tomer, Hakim Lukman, Sindhwani Puneet, Franco Giorgio, Singh Rajender, Giacone Filippo, Ruzaev Mikhail, Kosgi Raghavender, Sofikitis Nikolaos, Palani Ayad, Calik Gokhan, Kulaksız Deniz, Jezek Davor, Al Hashmi Manaf, Drakopoulos Panagiotis, Omran Huda, Leonardi Sofia, Celik-Ozenci Ciler, Güngör Nur Dokuzeylül, Ramsay Jonathan, Amano Toshiyasu, Sogutdelen Emrullah, Duarsa Gede Wirya Kusuma, Chiba Koji, Jindal Sunil, Savira Missy, Boeri Luca, Borges Edson, Gupte Deepak, Gokalp Fatih, Hebrard Guadalupe Hernández, Minhas Suks, Shah Rupin
机构信息
Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA.
Cleveland Clinic Foundation, Cleveland, OH, USA.
出版信息
World J Mens Health. 2023 Oct;41(4):809-847. doi: 10.5534/wjmh.230008. Epub 2023 Apr 20.
PURPOSE
Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition.
MATERIALS AND METHODS
An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method.
RESULTS
A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated.
CONCLUSIONS
This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.
目的
精子DNA碎片率（SDF）与男性不育及辅助生殖技术（ART）的不良结局相关。本研究旨在调查全球范围内对不育男性SDF升高的管理实践，总结相关专业学会的建议，并为管理这种情况提供专家建议。
材料与方法
根据CHERRIES清单标准，向生殖临床医生开展了一项关于SDF相关临床实践的在线全球调查。收集了与SDF相关的各种情况的管理方案，并与专业学会指南中的相关建议及现有适当证据进行比较。然后采用德尔菲法制定并调整了关于SDF升高的不育男性管理的专家建议和共识。
结果
来自55个不同国家的436名专家提交了回复。作为初始方法，79.1%的生殖专家建议对SDF升高的不育男性进行生活方式调整，76.9%的专家开具经验性抗氧化剂。关于抗氧化剂的使用时长，39.3%的专家建议为4 - 6个月，38.1%的专家建议为3个月。对于不明原因或特发性不育的男性以及与SDF升高相关的反复流产的夫妇，大多数受访者在保守和经验性药物治疗失败6个月后推荐进行ART。31.4%的受访者建议对临床诊断为精索静脉曲张、常规精液参数正常但SDF升高的不育男性在诊断后立即进行精索静脉曲张修复，40.9%的受访者建议在抗氧化剂和保守措施失败后进行修复。精子选择技术和睾丸精子提取也是接受ART的夫妇的管理选择。对于大多数问题而言，实践情况存在差异。
结论
本文展示了一项关于SDF升高的不育男性管理的大型全球调查结果，揭示了临床医生之间缺乏共识。此外，还表明在这方面专业学会指南较少，并试图突出相关证据。提出专家建议以帮助指导临床医生。
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