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Re: Diagnostic and therapeutic workup of male infertility: results from a Delphi Consensus Panel

International Journal of Impotence Research volume 35, pages 411–412 (2023)Cite this article

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The recent paper by Boeri et al. is a consensus statement based on clinical practice patterns of a group of Italian andrologists (n = 68) on topics related to the management of male factor infertility (MFI) [1]. The selected topics included laboratory testing and cryopreservation, ultrasound imaging, seminal infections and inflammation, lifestyle factors, treatment with nutraceuticals and dietary supplements, hormonal therapy, varicocele and azoospermia. A first-round voting was performed via a web-based anonymous online survey using a Delphi approach. A second-round voting was performed during an in-person conference in Palermo on July 2-3, 2021. Consensus was considered when the sum of disagreement/agreement reached a minimum of 66%. This is a commentary on some of the important conclusions of this study.

The study by Boeri et al. indicates that majority of survey participants recommend sperm DNA fragmentation (SDF) testing in selected conditions that include varicocele, high reactive oxygen species (ROS), history of antineoplastic treatments in the past, previously failed assisted reproductive technologies (ARTs), or recurrent pregnancy loss. These results are in line with recent recommendations on the utility of SDF test in the management of MFI [2, 3]. The latest 6th edition of the WHO manual for semen analysis [4] states that “the evaluation of SDF could constitute an important addition in the work-up of male infertility” that can be ordered in certain clinical situations [4]. The endorsement of SDF test as an extended test of semen is considered as an important step that may have a significant impact on the future management of male infertility [5].

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References

  1. Boeri L, Capogrosso P, Ortensi I, Miacola C, Cai T, Verze P, et al. Diagnostic and therapeutic workup of male infertility: results from a Delphi consensus panel. Int J Impot Res. 2021. https://doi.org/10.1038/s41443-021-00511-x.

  2. Agarwal A, Majzoub A, Baskaran S, Panner Selvam MK, Cho CL, Henkel R, et al. Sperm DNA fragmentation: a new guideline for clinicians. World J Mens Health. 2020;38:412–71.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Agarwal A, Farkouh A, Parekh N, Zini A, Arafa M, Kandil H, et al. Sperm DNA fragmentation: a critical assessment of clinical practice guidelines. World J Mens Health. 2022;40:30–37. https://doi.org/10.5534/wjmh.210056.

    Article  PubMed  Google Scholar 

  4. World Health Organization. WHO laboratory manual for the examination and processing of human semen, 6th ed.; WHO Press: Geneva, Switzerland; 2021. https://www.who.int/publications/i/item/9789240030787. Accessed 3 Dec 2021.

  5. Boitrelle F, Shah R, Saleh R, Henkel R, Kandil H, Chung E, et al. The Sixth Edition of the WHO manual for human semen analysis: a critical review and SWOT analysis. Life. 2021;11:1368 https://doi.org/10.3390/life11121368.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Gupta S, Sharma R, Agarwal A, Boitrelle F, Finelli R, Farkouh A, et al. Antisperm antibody testing: a comprehensive review of its role in the management of immunological male infertility and results of a global survey of clinical practices. World J Mens Health. 2022. https://doi.org/10.5534/wjmh.210164.

  7. Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol. 2021;205:36–43.

    Article  PubMed  Google Scholar 

  8. Agarwal A, Parekh N, Panner Selvam MK, Henkel R, Shah R, Homa ST, et al. Male Oxidative 810 Stress Infertility (MOSI): proposed terminology and clinical practice guidelines for 37 811 management of idiopathic male infertility. World J Mens Health. 2019;37:296–312. https://doi.org/10.5534/wjmh.190055.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Salonia, A, Bettocchi, C, Boeri L, Capogrosso P, Carvalho, J, Cilesiz NC, et al. EAU guidelines on sexual and reproductive health. 2021. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2021-V3.pdf.

  10. Ventimiglia E, Capogrosso P, Boeri L, Cazzaniga W, Matloob R, Pozzi E, et al. Leukocytospermia is not an informative predictor of positive semen culture in infertile men: results from a validation study of available guidelines. Hum Reprod Open. 2020;2020:hoaa039.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sharma R, Gupta S, Agarwal A, Henkel R, Finelli R, Parekh N, et al. Relevance of leukocytospermia and semen culture and its true place in diagnosing and treating male infertility. World J Mens Health. 2021;39:e32 https://doi.org/10.5534/wjmh.210063.

    Article  Google Scholar 

  12. Agarwal A, Finelli R, Selvam MKP, Leisegang K, Majzoub A, Tadros N, et al. A global survey of reproductive specialists to determine the clinical utility of oxidative stress testing and antioxidant use in male infertility. World J Mens Health. 2021. https://doi.org/10.5534/wjmh.210025.

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Authors and Affiliations

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

    Ramadan Saleh

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

    Ramadan Saleh

  3. American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

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

    Rupin Shah

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  1. Ramadan Saleh
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  2. Ashok Agarwal
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  3. Rupin Shah
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RAS and RS participated in drafting the commentary. RAS, RS and AA edited and revised commentary. All authors read and approved final version of commentary.

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Correspondence to Ashok Agarwal.

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Saleh, R., Agarwal, A. & Shah, R. Re: Diagnostic and therapeutic workup of male infertility: results from a Delphi Consensus Panel. Int J Impot Res 35, 411–412 (2023). https://doi.org/10.1038/s41443-022-00564-6

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