Table 4. Answers of questions related to management of ART failure and elevated SDF.
| Option | Overall responses | Urology/andrologya | Other specialtiesa | p-valuea | |
|---|---|---|---|---|---|
| In a couple with a normal female partner experiencing failure to achieve a clinical pregnancy after IUI, associated with elevated SDF in the male partner, what would your management strategy be? | |||||
| Repeat the procedure after applying conservative measures (shorter abstinence, antioxidants) | 133 (33.5) | 94 (37.5) | 39 (26.7) | 0.01 | |
| Refer for ICSI using techniques to select sperm with lower SDF | 68 (17.1) | 44 (17.5) | 24 (16.4) | ||
| Refer for ICSI with ejaculated sperm | 62 (15.6) | 29 (11.5) | 33 (22.6) | ||
| Repeat IUI using techniques to select sperm with lower SDF | 44 (11.1) | 29 (11.5) | 15 (10.3) | ||
| Refer for ICSI using testicular sperm | 34 (8.6) | 26 (10.4) | 8 (5.5) | ||
| Repeat the procedure with no additional intervention | 11 (2.8) | 5 (2.0) | 6 (4.1) | ||
| Not applicable | 45 (11.3) | 24 (9.6) | 21 (14.4) | ||
| Total | 397 (100) | 251 (100) | 146 (100) | ||
| In a couple with a normal female partner experiencing miscarriage after IUI, associated with elevated SDF in the male partner, what would your management strategy be? | |||||
| Repeat the procedure after applying conservative measures (shorter abstinence, antioxidants) | 115 (28.9) | 82 (32.8) | 33 (22.3) | 0.001 | |
| Refer for ICSI using techniques to select sperm with lower SDF | 86 (21.6) | 53 (21.2) | 33 (22.3) | ||
| Repeat IUI using techniques to select sperm with lower SDF | 56 (14.1) | 32 (12.8) | 24 (16.2) | ||
| Refer for ICSI with ejaculated sperm | 46 (11.6) | 22 (8.8) | 24 (16.2) | ||
| Refer for ICSI using testicular sperm | 38 (9.5) | 32 (12.8) | 6 (4.1) | ||
| Repeat the procedure with no additional intervention | 12 (3.0) | 5 (2.0) | 7 (4.7) | ||
| Not applicable | 45 (11.3) | 24 (9.6) | 21 (14.2) | ||
| Total | 398 (100) | 250 (100) | 148 (100) | ||
| In a couple with a normal female partner experiencing fertilization failure after IVF, associated with elevated SDF in the male partner, what would your management strategy be? | |||||
| Refer for ICSI using techniques to select sperm with lower SDF | 107 (26.7) | 62 (24.7) | 45 (30.0) | 0.05 | |
| Repeat the procedure after applying conservative measures (shorter abstinence, antioxidants) | 73 (18.2) | 50 (19.9) | 23 (15.4) | ||
| Refer for ICSI using testicular sperm | 63 (15.7) | 46 (18.3) | 17 (11.3) | ||
| Refer for ICSI with ejaculated sperm | 61 (15.2) | 32 (12.8) | 29 (19.3) | ||
| Repeat IVF using techniques to select sperm with lower SDF | 46 (11.5) | 34 (13.5) | 12 (8.0) | ||
| Repeat the procedure with no additional intervention | 5 (1.2) | 3 (1.2) | 2 (1.3) | ||
| Not applicable | 46 (11.5) | 24 (9.6) | 22 (14.7) | ||
| Total | 401 (100) | 251 (100) | 150 (100) | ||
| In a couple with a normal female partner experiencing failure to achieve a clinical pregnancy after IVF, associated with elevated SDF in the male partner, what would your management strategy be? | |||||
| Refer for ICSI using techniques to select sperm with lower SDF | 108 (26.9) | 69 (27.5) | 39 (26.0) | 0.3 | |
| Repeat the procedure after applying conservative measures (shorter abstinence, antioxidants) | 74 (18.5) | 50 (19.9) | 24 (16.0) | ||
| Refer for ICSI using testicular sperm | 73 (18.2) | 50 (19.9) | 23 (15.4) | ||
| Refer for ICSI with ejaculated sperm | 52 (13.0) | 26 (10.4) | 26 (17.3) | ||
| Repeat IVF using techniques to select sperm with lower SDF | 45 (11.2) | 30 (11.9) | 15 (10.0) | ||
| Repeat the procedure with no additional intervention | 5 (1.2) | 3 (1.2) | 2 (1.3) | ||
| Not applicable | 44 (11.0) | 23 (9.2) | 21 (14.0) | ||
| Total | 401 (100) | 251 (100) | 150 (100) | ||
| In a couple with a normal female partner experiencing miscarriage after IVF or ICSI, associated with elevated SDF in the male partner and no other abnormality, what would your management strategy be? | |||||
| Repeat IVF or ICSI using techniques to select sperm with lower SDF | 128 (32.0) | 74 (29.5) | 54 (36.2) | 0.05 | |
| Refer for ICSI using testicular sperm | 118 (29.5) | 86 (34.3) | 32 (21.5) | ||
| Repeat the procedure after applying conservative measures (shorter abstinence, antioxidants) | 92 (23.0) | 58 (23.1) | 34 (22.8) | ||
| Repeat the procedure with no additional intervention | 11 (2.7) | 5 (1.9) | 6 (4.0) | ||
| Transfer to another center | 5 (1.3) | 4 (1.6) | 1 (0.7) | ||
| Not applicable | 46 (11.5) | 24 (9.6) | 22 (14.8) | ||
| Total | 400 (100) | 251 (100) | 149 (100) | ||
Values are presented as number (%).
For each option, overall answers are presented in descending order in the first column. The answers are then stratified according to specialty into urology/andrology vs. other specialties.
ART: assisted reproductive technology, ICSI: intracytoplasmic sperm injection, IUI: intrauterine insemination, IVF: in vitro fertilization, SDF: sperm DNA fragmentation.
aThe p-value in the last column represents the overall comparison between the responses of urologists/andrologists when compared to other specialties (the two columns marked with a) using Fischer’s exact test; a value <0.05 is considered a significant difference.