Table 2. Comparison of recommendations by both guidelines.
| Agarwal et al (2020) [18] | Esteves et al (2020) [19] | |
|---|---|---|
| Technical aspects regarding SDF testing | ||
| Assays used to measure SDF are: TUNEL, SCSA, SCD, and Comet | The four assays were discussed as those used for SDF testing, along with pros, cons, and estimated cost | The four assays were described and any of the four is recommended to test for SDF (Grade B) |
| No explicit recommendations | ||
| Conditions for testing | No recommendation | Recommendations regarding abstinence length and dealing with frozen specimens were made (various grades) |
| Thresholds for discriminating fertile and infertile men | Cut-off of 20% described in text | Cut-off of 20% (SCSA, TUNEL, SCD) and 26% (Comet) (Grade B) |
| No explicit recommendations | ||
| Thresholds for predicting reproductive outcomes | Various cut-off values in different conditions summarized in a table | Thresholds exceeding 20-30% indicate a higher likelihood of adverse reproductive outcomes (Grade B) |
| No explicit recommendations | ||
| Indications for SDF testing | ||
| UMI & IMI | Recommended (Grade C) | Recommended (Grades B-C) |
| RPL | Recommended (Grade C) | Recommended (Grades B-C) |
| IUI | Recommended (Grade C) (before or after failure) | Recommended (Grades B-C) (before or after failure) |
| IVF | Recommended (Grade C) (before or after failure) | Recommended (Grades B-C) (before or after failure) |
| ICSI | Recommended (Grades B-C) (only after failure due to recurrent miscarriage) | Recommended (Grades B-C) (before and after failure) |
| Clinical varicocele | Recommended (Grade C) | Recommended (Grade C) |
| Risk factors | Recommended (Grade C) | Recommended (Grade C) |
| Sperm cryopreservation | No recommendation | Recommended (Grade D) |
| Management of SDF | ||
| Antioxidant use | Recommended (Grade C) | No recommendation |
| Recurrent ejaculation | Recommended (Grade C) | No recommendation |
| Control of inflammation | Recommended (Grade C) | No recommendation |
| Lifestyle modification | Recommended (Grade C) | Recommended within the context of testing |
| Varicocelectomy | Recommended (Grades B-C) | Discussed within the context of testing |
| No explicit recommendation | ||
| ICSI if persistently high SDF | Recommended (Grade C) | Recommended (Grades B-D) - grades varied depending on context of elevated SDF (UMI/IMI/RPL or IUI or IVF or risk factors) |
| Alternative Method of Sperm Selection after failed ICSI | Recommended (Grades B-C) | No recommendation |
| Testicular Sperm after failed ICSI | Recommended (Grades B-C) | Recommended (Grade B) |
Grades for recommendations are based on Oxford Centre for Evidence-Based Medicine (OCEBM) grades of recommendation.
SDF: sperm DNA fragmentation, TUNEL: terminal deoxynucleotidyl transferase dUTP nick end labelling, SCSA: sperm chromatin structure assay, SCD; sperm chromatin dispersion, UMI: unexplained male infertility, IMI: idiopathic male infertility, RPL: recurrent pregnancy loss, IUI: intrauterine insemination, IVF: in vitro fertilization, ICSI: intracytoplasmic sperm injection.