男性不育症中精子DNA碎片化检测的技术方面与临床局限性：一项全球调查、现行指南及专家建议
Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
作者信息
Agarwal Ashok, Farkouh Ala'a, Saleh Ramadan, Hamoda Taha Abo-Almagd Abdel-Meguid, Salvio Gianmaria, Boitrelle Florence, Harraz Ahmed M, Ghayda Ramy Abou, Kavoussi Parviz, Gül Murat, Toprak Tuncay, Russo Giorgio Ivan, Durairajanayagam Damayanthi, Rambhatla Amarnath, Birowo Ponco, Cannarella Rossella, Phuoc Nguyen Ho Vinh, Zini Armand, Arafa Mohamed, Wyns Christine, Tremellen Kelton, Sarıkaya Selçuk, Lewis Sheena, Evenson Donald P, Ko Edmund, Calogero Aldo E, Bahar Fahmi, Martínez Marlon, Ambar Rafael F, Colpi Giovanni M, Bakircioglu Mustafa Emre, Henkel Ralf, Kandil Hussein, Serefoglu Ege Can, Alfakhri Abdullah, Tsujimura Akira, Kheradmand Alireza, 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, Quang Nguyen, Pinggera Germar-Michael, Kothari Priyank, Micic Sava, Homa Sheryl, Long Tran Quang Tien, Zohdy Wael, Atmoko Widi, Ibrahim Wael, Sabbaghian Marjan, Abumelha Saad Mohammed, Chung Eric, Ugur Muhammet Rasit, Ozkent Mehmet Serkan, Selim Osama, Darbandi Mahsa, Fukuhara Shinichiro, Jamali Mounir, de la Rosette Jean, Kuroda Shinnosuke, Smith Ryan P, Baser Aykut, Kalkanli Arif, Tadros Nicholas N, Aydos Kaan, Mierzwa Tiago Cesar, Khalafalla Kareim, Malhotra Vineet, Moussa Mohamad, Finocchi Federica, Rachman Rinaldo Indra, Giulioni Carlo, Avidor-Reiss Tomer, Kahraman Oguzhan, Çeker Gökhan, Zenoaga-Barbăroșie Cătălina, Barrett Trenton L, Yilmaz Mehmet, Kadioglu Ates, Jindal Sunil, Omran Huda, Bocu Kadir, Karthikeyan Vilvapathy Senguttuvan, Franco Giorgio, Solorzano Jesús Fernando, Vishwakarma Ranjit B, Arianto Eko, Garrido Nicolas, Jain Divyanu, Gherabi Nazim, Sokolakis Ioannis, Palani Ayad, Calik Gokhan, Kulaksiz Deniz, Simanaviciene Vaida, Simopoulou Mara, Güngör Nur Dokuzeylül, Blecher Gideon, Falcone Marco, Jezek Davor, Preto Mirko, Amar Edouard, Le Tan V, Ahn Sun Tae, Rezano Andri, Singh Keerti, Rocco Lucia, Savira Missy, Rajmil Osvaldo, Darbandi Sara, Sogutdelen Emrullah, Boeri Luca, Hernández Guadalupe, Hakim Lukman, Morimoto Yoshiharu, Japari Andrian, Sofikitis Nikolaos, Altay Baris, Metin Mahmutoglu Asli, Al Hashimi Manaf, Ziouziou Imad, Anagnostopoulou Christina, Lin Haocheng, Shah Rupin
机构信息
Global Andrology Forum, Moreland Hills, OH, USA.
Cleveland Clinic, Cleveland, OH, USA.
出版信息
World J Mens Health. 2024 Jan;42(1):202-215. doi: 10.5534/wjmh.230076. Epub 2023 Aug 24.
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.
目的
精子DNA碎片化（SDF）是一种功能性精子异常，可影响生殖潜能，在最近出版的世界卫生组织人类精液检查与处理实验室手册第六版中描述了四种检测方法。本研究的目的是调查与SDF检测方法使用相关的全球实践情况，并调查临床医生在将这些检测纳入其临床实践中所面临的障碍和限制。
材料与方法
邀请管理男性不育症的临床医生完成一项关于SDF诊断和治疗方法相关实践的在线调查。他们对SDF检测技术方面、当前专业协会指南以及文献的回答被用于通过德尔菲法生成专家建议。最后，记录了临床医生在日常实践中遇到的与SDF相关的挑战。
结果
436名生殖临床医生完成了调查。总体而言，末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法（TUNEL）是最常用的检测方法，占28.6%，其次是精子染色质结构分析（24.1%）和精子染色质扩散分析（19.1%）。检测方法的选择在很大程度上受可用性影响（70%的受访者）。30%的阈值是33.7%的临床医生选择的SDF升高的最常用临界值。在受访者中，53.6%建议禁欲3至5天后进行SDF检测。尽管75.3%的人认为SDF检测可为许多不明原因的不育症提供解释，但受访者选择的主要限制因素是缺乏专业协会指南建议（62.7%）以及缺乏全球公认的SDF解释参考标准（50.3%）。
结论
本研究是关于SDF检测技术方面以及临床医生所遇到障碍的最大规模全球调查。关于临床医生实施SDF检测和标准实验室解释的统一全球建议至关重要。
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