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Agarwal et al. Transl Androl Urol 2017
Indications
Clinical Varicocele
• SDFtestingisrecommendedinpatientswithgrade2/3varicocelewithnormal conventional semen parameters (grade C recommendation)
• SDFtestingisrecommendedinpatientswithgrade1varicocelewith borderline/abnormal conventional semen parameter results (grade C recommendation)
Unexplained infertility/IUI failure/RPL
• SDFtestingshouldbeofferedtoinfertilecoupleswithRPLorpriortoinitiatingIUI (grade C recommendation)
• EarlyIVForICSImaybeanalternativetoinfertilecouplewithRPLorfailedIUI (grade C recommendation)
IVF and/or ICSI failure
• SDF testing is indicated in patients with recurrent failure of assisted reproduction (grade C recommendation)
• The use of testicular sperm rather than ejaculated sperm may be beneficial in men with oligozoospermia, high SDF and recurrent IVF failure (grade B–C recommendation)
Borderline abnormal (or normal) semen parameters with risk factor
SDF testing should be offered to patients who have a modifiable lifestyle risk factor of male infertility (grade C recommendation)
SDF Tests
Grade B-C recommendation:
• NeatsemensampleshouldbeusedforSDFtesting
• Afixedejaculatoryabstinencebeforecollectionof
semen sample should be applied
• Astandardizedprotocolwithstringentqualitycontrol
is essential for a reliable SDF testing result
• SDFthresholdreflectstheprobabilityonreproductive
outcome
Esteves, 39
Vol 6, Supplement 4 (September 2017): Translational Andrology and Urology (Sperm DNA Fragmentation)
58 experts from six continents and 22 countries contributed commentaries
• 88% overall supportive
100 80 60
%
40
20 0
Supportive without reservation Supportive with reservation Not supportive
Neutral
Overall (n=58)
Americas (n=27)
Europe Asia (n=16) (n=12)
Africa (n=2)
Oceania (n=1)
Countries (number of participants): United States (n=19), Brazil (n=4), Canada (n=3), and Argentina (n=1) [Americas]; Italy (n=4), France (n=3), Spain (n=3), Turkey (n=2), United Kingdom (n=1), Denmark (n=1), Belgium (n=1), Poland (n=1) [Europe]; India (n=6), China (n=1), Iran (n=1), Malaysia (n=1), Qatar (n=1), Pakistan (n=1), Israel (n=1) [Asia]; South Africa (n=1), Egypt (n= 1) [Africa], Australia (n=1) [Oceania]
*Agarwal A, Majzoub A, Esteves SC, Ko E, Ramasamy R, Zini A. Clinical utility of sperm DNA fragmentationtesting:practicerecommendationsbasedonclinicalscenarios. TranslAndrolUrol 2016;5(6):935-950.
Esteves et al. Transl Androl Urol 2017
Esteves, 40
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