Ashok Agarwal

Ashok Agarwal
Cleveland Clinic · American Center for Reproductive Medicine

PhD

About

2,395
Publications
1,038,891
Reads
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87,555
Citations
Introduction
Ashok Agarwal, PhD, HCLD (ABB), ELD (ACE), is the Director of the Andrology Center, and Director of Research at the American Center for Reproductive Medicine since 1993. He holds these positions at The Cleveland Clinic Foundation, USA, where he is a Professor at the Lerner College of Medicine of Case Western Reserve University. Ashok was the Director of Male Infertility Research and an Asst. Professor of Urology at the Brigham and Women's Hospital & Harvard Medical School, Boston from 1988 - 92.
Additional affiliations
July 1975 - November 1983
Banaras Hindu University
Position
  • Research Associate
January 1993 - present
Cleveland Clinic
Position
  • Managing Director
Description
  • Director of Research in Male Infertility
July 1988 - December 1992
Harvard Medical School
Position
  • Professor (Assistant)
Description
  • Director of Male Infertility Research in the Division of Urology, Harvard Program in Urology, Brigham and Women's Hospital, Boston, MA
Education
June 1984 - June 1986
Harvard Medical School
Field of study
  • Reproductive Biology

Publications

Publications (2,395)
Research
Complete list of research publication by Dr. Ashok Agarwal and the members of his team both at Harvard Medical School (1987-1992) and the Cleveland Clinic (1993-2017) is available through Scopus.
Article
Introduction Erectile dysfunction (ED) affects approximately 40% of men; however, the true prevalence remains uncertain owing to various factors. Diagnosing ED is challenging, and tools like the International Index of Erectile Function (IIEF) and its shorter version, the IIEF-5, are commonly used to assess its severity. Although nocturnal penile tu...
Article
Azoospermia, defined as the absence of sperm in the ejaculate, is a well-documented consequence of exogenous testosterone (ET) and anabolic–androgenic steroid (AAS) use. These agents suppress the hypothalamic–pituitary–gonadal (HPG) axis, leading to reduced intratesticular testosterone levels and impaired spermatogenesis. This review examines the p...
Article
Full-text available
Purpose: This study investigated 1) the frequency of quotation errors in multi-authored medical manuscripts in andrology, 2) analyzed common types of quotation errors and the methods used to rectify them, and 3) evaluated their impact on manuscript accuracy, credibility, and research conclusions. Materials and methods: Twelve manuscripts written...
Article
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The ideal morphology of the sperm cell was initially described based on the characteristics of sperm able to migrate through the endocervical canal assuming these had the best fertilization potential. Sperm morphology assessment has moved over the years toward stricter criteria based on the findings from studies that underline its value in successf...
Article
Full-text available
Male factor infertility is a multifaceted problem that affects approximately 50% of couples suffering from infertility. Causes of male infertility include endocrine disturbances, gonadotoxins, genetic abnormalities, varicocele, malignancies, infections, congenital or acquired urogenital abnormalities, iatrogenic factors, immunological factors, and...
Article
Full-text available
Purpose: The objective of this manuscript is to assess the effect of varicocele repair (VR) in patients with clinical varicoceles on serum total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B serum levels. Materials and methods: The study was performed in compliance with the Meta-Analysis and Systematic...
Article
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Vasectomy is a reliable male contraceptive method with a success rate exceeding 98%. Despite its efficacy, vasectomy is not foolproof, with potential early and late failures requiring careful postoperative monitoring via post-vasectomy semen analysis (PVSA). Published guidelines emphasize the necessity of conducting PVSA to ensure clinical sterilit...
Article
Full-text available
Male infertility represents a significant global problem due to its essential health, social, and economic implications. It is unsurprising that scientific research is very active in this area and that advances in the diagnostic and therapeutic fields are notable. This review presents the main diagnostic advances in male infertility, starting from...
Article
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Purpose: In this systematic review and meta-analysis, we investigated assisted reproductive technology (ART) success in infertile men with clinical varicocele and abnormal semen parameters who underwent varicocele repair (VR) before the ART procedure as compared to those who did not. Materials and methods: A comprehensive search of the Scopus, P...
Article
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Purpose: Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investi...
Article
Full-text available
Background Increased oxidative stress (OS), resulting from the delicate balance between reactive oxygen species (ROS) production and antioxidant defense, is closely linked to sperm abnormalities and male subfertility. Elevated ROS levels particularly affect sperm quality. The vulnerability of spermatozoa to ROS is due to the absence of DNA repair m...
Chapter
The World Health Organization (WHO) manual for human semen examination is a guide for laboratory personnel on how to do a standardized semen analysis. In this respect, the 6th edition has done an excellent job of streamlining the process, providing a timeline for the various steps, eliminating tests which were redundant or unnecessary and including...
Article
Full-text available
Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines.Materials and Methods: Materials and Methods: A 39-question survey was developed by senior Global Andr...
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Purpose The purpose of this narrative review is to provide a practical understanding of sperm DNA fragmentation (SDF) in the management of male infertility. Methods A search for systematic reviews and meta-analyses (SRMA) on SDF between April 1st, 2018 and April 1st, 2023 was performed using PubMed and articles were selected as per their relevance...
Article
Artificial intelligence (AI) is revolutionizing the current approach to medicine. AI uses machine learning algorithms to predict the success of therapeutic procedures or assist the clinician in the decision-making process. To date, machine learning studies in the andrological field have mainly focused on prostate cancer imaging and management. Howe...
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There has been much controversy about the true value of varicocele repair for improving fertility and the chances of natural conception. This review summarizes the latest research findings, current professional societies' recommendations, and the conclusions of recent systematic reviews and meta-analyses. The current evidence suggests a positive ro...
Article
Full-text available
Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, its association with anti-sperm antibodies (ASA) remains controversial. This systematic review and meta-analysis (SRMA) aims to investigate the frequency of ASA positivity in men with varicocele. Materials and methods: This SRMA is conducted in accordanc...
Article
Full-text available
Purpose: Varicocele has been associated with high seminal oxidative stress (OS), impaired semen quality, and reduced male fertility potential. However, the exact mechanism(s) underlying the development of varicocele-mediated infertility and the cause-effect relationship between varicocele and testicular dysfunction are not fully understood. The ai...
Article
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Binge Eating Disorder (BED) is a governing and incapacitating insane condition characterized by recurrent scenes of absorbing large quantities of snacks, followed by a sense of misfortune, loss of control, and distress. This research investigates the versatile dimensions of BED, directed at allure plant structure, amount, disease, and situation. Em...
Article
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Oxidative stress is one of the main mechanisms responsible for male infertility. Various conditions such as varicocele, obesity, advanced age, and lifestyle can lead to an increase in reactive oxygen species, causing an oxidative imbalance in the reproductive environment. Spermatozoa are sensitive to reactive oxygen species and require energy to ca...
Article
Full-text available
Background and Objective Basic semen analysis is the first step in the evaluation of male infertility. It includes an assessment of sperm morphology which is believed to reflect on overall spermatogenesis and sperm function. Teratozoospermia, defined as abnormal sperm morphology, is frequently present in association with severe oligoasthenozoosperm...
Article
Background and Aims: Sperm DNA fragmentation (SDF) is caused by apoptosis, oxidative stress or incomplete chromatin maturation and can result in male infertility and poor reproductive outcomes. Despite growing trends, there are no specific recommendations on specific diagnostic tests used, assay cut-offs or abstinence periods prior to SDF testing....
Article
Background and Aims: Non-obstructive azoospermia (NOA) is the most common form of male infertility, characterized by an absence of sperm in ejaculate and is caused by testicular failure. While NOA afflicts 10-38.3% of infertile males, there is no specific recommendations in EAA/EAU guidelines on its clinical diagnosis or WHO guidelines on semen ana...
Article
Full-text available
Purpose: 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 met...
Article
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There have been many significant scientific advances in the diagnostics and treatment modalities in the field of male infertility in recent decades. Examples of these include assisted reproductive technologies, sperm selection techniques for intracytoplasmic sperm injection, surgical procedures for sperm retrieval, and novel tests of sperm function...
Article
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Background Semen analysis is the cornerstone for male fertility evaluation. In 2021, the World Health Organization (WHO) released its 6th edition of semen analysis manual. Methods We highlight the main changes in the latest 6th edition of the WHO manual of semen analysis and their possible interpretations. Results The manual is highly comprehensi...
Article
Full-text available
Background Varicocele is a common occurrence, particularly among men with primary and secondary infertility. There has been extensive research into the management of varicocele in the context of male infertility. Methods This article aims to explore the variations in clinical practice in diagnosing and managing varicoceles in infertile men. A summ...
Article
Full-text available
Objectives Sperm DNA fragmentation (SDF) is a molecular marker of sperm chromatin health. Elevated SDF is associated with male infertility, recurrent pregnancy loss, and failure of assisted reproductive technologies (ART). In 2021, the sixth edition of the World Health Organization (WHO) Manual for the Laboratory Examination and Processing of Human...
Article
Full-text available
Background: In many countries, the stereotype that women are to blame for infertility in relationships remains prevalent, even though approximately half of the cases are caused by male factors. This study aimed to determine the knowledge, attitudes, and practices of infertile couples in urban areas with regard to male infertility. Methods: A web-ba...
Article
Full-text available
Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recom...
Article
Full-text available
Purpose: 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 t...
Article
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Purpose: This is the first study to assess the impact of an online microsurgical testicular sperm extraction (mTESE) masterclass. We: 1) describe the masterclass’s scientific content; 2) appraise participants’ acquisition of knowledge; 3) gauge whether extent of improvement of participants’ knowledge/skills were influenced by demographic/profession...
Article
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Purpose: Despite all past efforts, the current guidelines are not explicit enough regarding the indications for performing azoospermia factor (AZF) screening and karyotype, burdening clinicians with the decision to assess whether such tests are meaningful for the infertile male patient. These assessments can be costly and it is up to the healthcar...
Article
Full-text available
Purpose 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...
Article
Epigenetics refers to how gene expression and function are modulated without modifying the DNA sequence but through subtle molecular changes or interactions with it. As spermatogenesis progresses, male germ cells suffer plenty of epigenetic modifications, resulting in the definitive epigenome of spermatozoa conditioning its functionality, and this...
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Artificial intelligence (AI) in medicine has gained a lot of momentum in the last decades and has been applied to various fields of medicine. Advances in computer science, medical informatics, robotics, and the need for personalized medicine have facilitated the role of AI in modern healthcare. Similarly, as in other fields, AI applications, such a...
Article
The body of evidence supports the negative impact of increased sperm DNA fragmentation (SDF) on natural fertility as well as assisted reproduction conditions. High SDF has been correlated with low pregnancy and delivery rates following intrauterine insemination. Also, high SDF is accused of reducing the rates of fertilization, implantation, pregnan...
Article
Intracytoplasmic sperm injection (ICSI) was initially introduced to overcome problems due of severe male factor infertility not being solved with conventional in-vitro fertilization (cIVF). However, recent years have witnessed an increasing use of ICSI by most assisted reproductive technique laboratories for non-male factor indications. Examples of...
Conference Paper
Introduction: Sperm DNA fragmentation (SDF) analysis has emerged as a paramount diagnostic tool elucidating the etiology underlying unexplained and idiopathic male infertility. Objective: This study aimed to investigate global clinical practices and perspectives on SDF testing among diverse medical specialists, in cases of unexplained and idiopat...
Article
Full-text available
Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recomm...
Article
Full-text available
Purpose: There are no published examples of a global online research collaborative in andrology. We describe the development, profile and member characteristics of the first consortium of this type, the Global Andrology Forum (GAF). Methods: An online survey sent to all GAF members collected demographic information (sex, age, experience, academic...
Article
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Since the first pioneering studies on time-lapse systems (TLSs) for embryo incubation, many things have changed. Two main factors influence the development of modern time-lapse incubators for human in-vitro fertilization (IVF): 1) the switch from traditional cell culture incubators to benchtops incubators, more suitable for human IVF; and 2) the im...
Article
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Male infertility is attributed to multiple factors including high levels of sperm DNA fragmentation (SDF). Conventional semen analysis continues to be the gold standard for diagnosis of male factor infertility around the world. However, the limitations of basic semen analysis have prompted the search for complementary assessments of sperm function...
Article
Full-text available
The identification of markers capable of evaluating oocyte quality, its maturation, function, and embryo progression and implantation potential has frequently initiated research interest. However, to date, univocal criteria of oocyte competence do not exist. A major cause of low oocyte quality is evidently advanced maternal age. However, other fact...
Article
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Purpose: This is the first study to design and assess a RCB specifically tailored for clinical and non-clinical andrology practitioners worldwide. We appraised: 1) the barriers and enablers to research among these practitioners; 2) attendees’ satisfaction with the webinar; and, 3) research knowledge acquisition as a result of the webinar (before/af...
Article
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Purpose: Systematic reviews and meta-analyses (SRMAs) are used to generate evidence-based guidelines. Although the number of SRMAs published in the literature has increased dramatically in the last decade, the training and the experience of the researchers performing the SRMAs are usually not explained in the SRMAs' methodology, and this may be a...
Article
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Background: Sperm chromatin dispersion (SCD) test is a common and inexpensive technique to assess sperm DNA fragmentation while its subjectivity with assessing small number of spermatozoa are the disadvantages. Objectives: To study the efficacy of a new SCD test kit (R10) combined with an artificial intelligence (AI)-aided halo evaluating platfo...
Chapter
In recent years, intracytoplasmic sperm injection (ICSI) has become the most performed method of assisted reproduction for infertile couples with severe male-factor infertility. Evidence supports that normal sperm morphology positively correlates with desired ICSI outcomes. Severe morphological defects of spermatozoa, especially of the head, are as...
Article
Full-text available
Infertility 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...
Article
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Introduction Metabolic Age (MetAge) and body composition analysis may reflect an individual’s metabolic status, which is believed to influence male sexual and gonadal functions. Although erectile dysfunction (ED) and hypogonadism are increasingly prevalent with age, they are also detected among younger men. This study aims to assess the impact of M...
Article
Full-text available
Purpose 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 varico...
Article
One principal purpose of assisted reproductive technology (ART) is to produce viable and good quality embryos. However, a variety of environmental factors may induce epigenetic changes in the embryo. Moreover, laboratory conditions including the culture media may also affect embryo development. Therefore, media change is an important factor in main...
Chapter
Retrograde ejaculation is an ejaculatory dysfunction that affects the fertility of a man. In this medical condition, seminal fluid is redirected into the bladder instead of going out through the urethra due to low-internal urethral sphincter resistance or insufficient relaxation of external urethral sphincter. Depending on the degree of damage, ret...
Chapter
In spermatozoa undergoing apoptosis, phosphatidylserine is translocated from the inner to the outer leaflet of the sperm membrane. The external translocation of phosphatidylserine is an early marker of apoptosis and it is recognized by annexin V protein. The principle of the sperm magnetic-activated cell sorting (MACS) technology is to separate mat...
Article
Full-text available
Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly usi...
Chapter
Full-text available
The management of infertile men with varicocele is highly debated. Varicocele repair (VR) can be either surgical (varicolectomy) or through angiographic embolization. Surgical repair of varicocele includes open non-microsurgical techniques whether inguinal (Ivanissevich) or high retroperitoneal ligation (Palomo), open microsurgical techniques (ingu...
Article
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Introduction Male infertility is a widespread disease with an etiology that is not always clear. A number of studies have reported a decrease in sperm production in the last forty years. Although the reasons are still undefined, the change in environmental conditions and the higher exposure to endocrine-disrupting chemicals (EDCs), namely bisphenol...
Article
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Biomedical science is rapidly developing in terms of more transparency, openness and reproducibility of scientific publications. This is even more important for all studies that are based on results from basic semen examination. Recently two concordant documents have been published: the 6th edition of the WHO Laboratory Manual for the Examination a...