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Öğe Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations(Korean Society for Sexual Medicine and Andrology, 2022) Shah, Rupin; Agarwal, Ashok; Kavoussi, Parviz; Rambhatla, Amarnath; Saleh, Ramadan; Cannarella, Rossella; Harraz, Ahmed M.; Boitrelle, Florence; Kuroda, Shinnosuke; Hamoda, Taha Abo-Almagd Abdel-Meguid; Zini, Armand; Ko, Edmund; Çalık, Gökhan; Toprak, Tuncay; Kandil, Hussein; Gül, Murat; Bakırcıoğlu, Mustafa Emre; Parekh, Neel; Russo, Giorgio Ivan; Tadros, Nicholas; Kadıoğlu, Ateş; Arafa, Mohamed; Chung, Eric; Rajmil, Osvaldo; Dimitriadis, Fotios; Malhotra, Vineet; Salvio, Gianmaria; Henkel, Ralf; Le, Tan V.; Sogutdelen, Emrullah; Vij, Sarah; Alarbid, Abdullah; Güdeloğlu, Ahmet; Tsujimura, Akira; Calogero, Aldo E.; El Meliegy, Amr; Crafa, Andrea; Kalkanlı, Arif; Baser, Aykut; Hazır, Berk; Giulioni, Carlo; Cho, Chak-Lam; Ho, Christopher C.K.; Salzano, Ciro; Zylbersztejn, Daniel Suslik; Tien, Dung Mai Ba; Pescatori, Edoardo; Borges, Edson; Saïs-Hamza, Eminej; Huyghe, Eric; Ceyhan, Erman; Caroppo, Ettore; Castiglioni, Fabrizio; Bahar, Fahmi; Gökalp, Fatih; Lombardo, Francesco; Gadda, Franco; Duarsa, Gede Wirya Kusuma; Pinggera, Germar-Michael; Busetto, Gian Maria; Balercia, Giancarlo; Cito, Gianmartin; Blecher, Gideon; Franco, Giorgio; Liguori, Giovanni; Elbardisi, Haitham; Keskin, Hakan; Lin, Haocheng; Taniguchi, Hisanori; Park, Hyun Jun; Ziouziou, Imad; de la Rosette, Jean J. M. C. H.; Hotaling, Jim; Ramsay, Jonathan; Molina, Juan Manuel Corral; Lo, Ka Lun; Böcü, Kadir; Khalafalla, Kareim; Bowa, Kasonde; Okada, Keisuke; Nagao, Koichi; Chiba, Koji; Hakim, Lukman; Makarounis, Konstantinos; Hehemann, Marah; Peña, Marcelo Rodriguez; Falcone, Marco; Bendayan, Marion; Martinez, Marlon; Timpano, Massimiliano; Altan, Mesut; Fode, Mikkel; Al-Marhoon, Mohamed S.; Gilani, Mohammad Ali Sadighi; Soebadi, Mohammad Ayodhia; Gherabi, Nazim; Sofikitis, Nikolaos; Kahraman, Oğuzhan; Birowo, Ponco; Kothari, Priyank; Sindhwani, Puneet; Javed, Qaisar; Ambar, Rafael F.; Kosgi, Raghavender; Ghayda, Ramy Abou; Adriansjah, Ricky; Condorelli, Rosita Angela; La Vignera, Sandro; Micic, Sava; Kim, Shannon Hee Kyung; Fukuhara, Shinichiro; Ahn, Sun Tae; Mostafa, Taymour; Ong, Teng Aik; Takeshima, Teppei; Amano, Toshiyasu; Barrett, Trenton; Arslan, Umut; Karthikeyan, Vilvapathy Senguttuvan; Atmoko, Widi; Yumura, Yasushi; Yuan, Yiming; Kato, Yuki; Jezek, Davor; Cheng, Bryan Kwun-Chung; Hatzichristodoulou, Georgios; Dy, Jun; Castañé, Eduard Ruiz; El-Sakka, Ahmed I.; Nguyen, Quang; Sarıkaya, Selçuk; Boeri, Luca; Tan, Ronny; Moussa, Mohamad A.; El-Assmy, Ahmed; Alali, Hamed; Alhathal, Naif; Osman, Yasser; Perovic, Dragoljub; Sajadi, Hesamoddin; Akhavizadegan, Hamed; Vu?ini?, Miroslav; Kattan, Said; Kattan, Mohamed S.; Mogharabian, Nasser; Phuoc, Nguyen Ho Vinh; Ngoo, Kay Seong; Alkandari, Mohammad H.; Alsuhaibani, Shaheed; Sokolakis, Ioannis; Babaei, Mehdi; King, Mak Siu; Diemer, Thorsten; Gava, Marcelo M.; Henrique, Raphael; Spinola e Silva, Rodrigo; Paul, Gustavo Marquesine; Mierzwa, Tiago Cesar; Glina, Sidney; Siddiqi, Kashif; Wu, Han; Wurzacher, Jana; Farkouh, Ala'a; Son, Hwancheol; Minhas, Suks; Lee, Joe; Magsanoc, Nikko; Capogrosso, Paolo; Capogrosso, Paolo; Albano, German Jose; Lewis, Sheena E.M.; Jayasena, Channa N.; Alvarez, Juan G.; Teo, Colin; Smith, Ryan P.; Chua, Jo Ben M.; Jensen, Christian Fuglesang S.; Parekattil, Sijo; Finelli, Renata; Durairajanayagam, Damayanthi; Karna, Keshab Kumar; Ahmed, Abdelkareem; Evenson, Don; Umemoto, Yukihiro; Puigvert, Ana; Çeker, Gökhan; Colpi, Giovanni M.; Rolitsky, Sarah; Bouzouita, Abderrazak; Shokeir, Ahmed; Aşçı, Ahmet; Bouker, Amin; Adamyan, Aram; Avoyan, Armen E.; Palani, Ayad; Aghamajidi, Azin; Eze, Balantine; Noegroho, Bambang Sasongko; Purnomo, Basuki; Erkan, Bircan Kolbaşı; Zilaitiene, Birute; Kulaksız, Deniz; Kafetzis, Dimitrios; Lee, Dong Sup; Stember, Doron; Evgeni, Evangelini; Alhajeri, Faisal; Finocchi, Federica; Colombo, Fulvio; Tsangaris, George; Sallam, Hassan N.; Acosta, Herik; Rosas, Israel Maldonado; Kirkman-Brown, Jackson; Shin, Jae Il; Sonksen, Jens; Dong, Jie; Marmar, Joel; Moreno-Sepulveda, Jose; Seo, Ju Tae; Aydos, Kaan; Kesari, Kavindra Kumar; Trost, Landon; Jenkins, Lawrence; Rocco, Lucia; Darbandi, Mahsa; Simopoulou, Mara; Alves, Marco; Sabbaghian, Marjan; Tavalaee, Marziyeh; Razi, Mazdak; Duran, Mesut Berkan; Nago, Mitsuru; Elkhouly, Mohamed; Khalili, Mohamed; Nasr-Esfahani, Mohammad Hossein; Kamath, Mohan S.; Uğur, Muhammet Raşit; Park, Nam Cheol; Cruz, Natalio; Garrido, Nicolas; Sodeifi, Niloofar; Al Khalidi, Noora; Shoshany, Ohad; Satyagraha, Paksi; Drakopoulos, Panagiotos; Vogiatzi, Paraskevi; Dolati, Parisa; Das, Partha; Chiu, Peter Ka-Fung; Tsioulou, Petroula A.; Patel, Premal; Singh, Rajender; Kaiyal, Raneen Sawaid; Santos, Ferreira; Dada, Rima; Brodjonegoro, Sakti; Banihani, Saleem Ali; Schon, Samantha; Darbandi, Sara; Güneş, Sezgin; Homa, Sheryl; Mutambirwa, Shingai; Roychoudhury, Shubhadeep; Diaz, Sofia Ines Leonardi; Gopalakrishnan, Sreelatha; Krawetz, Stephen; Jindal, Sunil; Avidor-Reiss, Tomer; Lin, Tsung Yen; Kumar, Vijay; Ibrahim, Wael; Kerkeni, Walid; Woo, Wongi; Morimoto, Yoshiharu; Cheng, Yu-ShengPurpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.Öğe Controversy and consensus on indications for sperm DNA fragmentation testing in male infertility: A global survey, current guidelines, and expert recommendations(Korean Society for Sexual Medicine and Andrology, 2023) Agarwal, Ashok; Farkouh, Ala'a; Saleh, Ramadan; Hamoda, Taha Abo-Almagd Abdel-Meguid; Harraz, Ahmed M.; Kavoussi, Parviz; Arafa, Mohamed; Palani, AyadPurpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.Öğe Effects of varicocele repair on sperm dna fragmentation and seminal malondialdehyde levels in infertile men with clinical varicocele a systematic review and meta-analysis(2024) Cannarella, Rossella; Shah, Rupin; Saleh, Ramadan; Boitrelle, Florence; Hamoda, Taha Abo-Almagd Abdel-Meguid; Singh, Rajender; Salvio, Gianmaria; Toprak, Tuncay; Falcone, Marco; Gül, Murat; Dimitriadis, Fotios; Rambhatla, Amarnath; Russo, Giorgio I.; Ko, Edmund; Zini, Armand; Kavoussi, Parviz; Phuoc, Nguyen Ho Vinh; Kandil, Hussein; Ghayda, Ramy Abou; Birowo, Ponco; Gherabi, Nazim; Ceyhan, Erman; Dong, Jie; Malhotra, Vineet; Durairajanayagam, Damayanthi; Kolbaşı, Bircan; Bahar, Fahmi; Çalık, Gökhan; Çayan, Selahittin; Pinggera, Germar Michael; Calogero, Aldo E.; Rajmil, Osvaldo; Mostafa, Taymour; Atmoko, Widi; Harraz, Ahmed M.; Le, Tan V.; de la Rosette, Jean J. M. C. H.; Hakim, Lukman; Pescatori, Edoardo; Sergeyev, Oleg; Rashed, Ayman; Saini, Pallavi; Agarwal, AshokPurpose: Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA). Materials and Methods: A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD). Results: Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I2=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I2=93.7%). Conclusions: Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.Öğe Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility: A global survey, current guidelines, and expert recommendations(Korean Society for Sexual Medicine and Andrology, 2023) Agarwal, Ashok; Farkouh, Ala’a; Saleh, Ramadan; Hamoda, Taha Abo-Almagd Abdel-Meguid; Salvio, Gianmaria; Boitrelle, Florence; Lin, Haocheng; Shah, RupinPurpose: 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.Öğe The renaissance of male infertility management in the golden age of andrology(Korean Society for Sexual Medicine and Andrology, 2023) Calogero, Aldo E.; Cannarella, Rossella; Agarwal, Ashok; Hamoda, Taha Abo-Almagd Abdel-Meguid; Rambhatla, Amarnath; Saleh, Ramadan; Boitrelle, Florence; Ziouziou, Imad; Toprak, Tuncay; Gül, Murat; Avidor-Reiss, Tomer; Kavoussi, Parviz; Chung, Eric; Birowo, Ponco; Ghayda, Ramy Abou; Ko, Edmund; Colpi, Giovanni; Dimitriadis, Fotios; Russo, Giorgio Ivan; Martinez, Marlon; Çalik, Gökhan; Kandil, Hussein; Salvio, Gianmaria; Mostafa, Taymour; Lin, Haocheng; Park, Hyun Jun; Gherabi, Nazim; Phuoc, Nguyen Ho Vinh; Quang, Nguyen; Adriansjah, Ricky; La Vignera, Sandro; Micic, Sava; Durairajanayagam, Damayanthi; Şerefoglu, Ege Can; Karthikeyan, Vilvapathy Senguttuvan; Kothari, Priyank; Atmoko, Widi; Shah, RupinInfertility affects nearly 186 million people worldwide and the male partner is the cause in about half of the cases. Meta-regression data indicate an unexplained decline in sperm concentration and total sperm count over the last four decades, with an increasing prevalence of male infertility. This suggests an urgent need to implement further basic and clinical research in Andrology. Andrology developed as a branch of urology, gynecology, endocrinology, and, dermatology. The first scientific journal devoted to andrological sciences was founded in 1969. Since then, despite great advancements, andrology has encountered several obstacles in its growth. In fact, for cultural reasons, the male partner has often been neglected in the diagnostic and therapeutic workup of the infertile couple. Furthermore, the development of assisted reproductive techniques (ART) has driven a strong impression that this biotechnology can overcome all forms of infertility, with a common belief that having a spermatozoon from a male partner (a sort of sperm donor) is all that is needed to achieve pregnancy. However, clinical practice has shown that the quality of the male gamete is important for a successful ART outcome. Furthermore, the safety of ART has been questioned because of the high prevalence of comorbidities in the offspring of ART conceptions compared to spontaneous conceptions. These issues have paved the way for more research and a greater understanding of the mechanisms of spermatogenesis and male infertility. Consequently, numerous discoveries have been made in the field of andrology, ranging from genetics to several "omics"technologies, oxidative stress and sperm DNA fragmentation, the sixth edition of the WHO manual, artificial intelligence, management of azoospermia, fertility in cancers survivors, artificial testis, 3D printing, gene engineering, stem cells therapy for spermatogenesis, and reconstructive microsurgery and seminal microbiome. Nevertheless, as many cases of male infertility remain idiopathic, further studies are required to improve the clinical management of infertile males. A multidisciplinary strategy involving both clinicians and scientists in basic, translational, and clinical research is the core principle that will allow andrology to overcome its limits and reach further goals. This state-of-the-art article aims to present a historical review of andrology, and, particularly, male infertility, from its "Middle Ages"to its "Renaissance", a golden age of andrology.
