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"Infertilitas pria paling banyak disebabkan oleh gangguan proses spermatogenesis. Androgen merupakan hormon yang sangat penting pada proses spermatogenesis. Aksi biologis hormon androgen terjadi melalui interaksi dengan reseptor androgen (RA) yang merupakan protein regulator transkripsi di dalam nukleus. Ekson 1 gen RA mengandung pengulangan trinukleotida CAG yang bersifat polimorfik. Polimorfisme pengulangan trinukleotida CAG ini diduga mempengaruhi aktivitas reseptor androgen. Penelitian meliputi isolasi DNA dari darah tepi dan amplifikasi fragmen pengulangan trinukleotida CAG gen RA dengan teknik PCR. Penentuan panjang pengulangan CAG gen RA dilakukan dengan elektroforesis pada gel poliakrilamid 6% yang mengandung zat pendenaturasi. Dari penelitian ini didapatkan perbedaan jumlah pengulangan CAG gen reseptor androgen antara pria oligozoospermia/azoospermia (24,3 ± 3,4) dan pria normozoospermia (22,7 ± 2,7). Berdasarkan uji t untuk sampel tidak berpasangan, perbedaan jumlah pengulangan CAG pada gen reseptor androgen antara kedua kelompok tersebut bermakna secara statistik (p = 0,031). Namun tidak ditemukan hubungan antara jumlah pengulangan CAG gen RA dengan konsentrasi sperma (rs = - 0,038; p = 0,775). Ini menunjukkan bahwa peningkatan jumlah pengulangan CAG gen RA bukan merupakan penyebab utama gangguan spermatogenesis. (Med J Indones 2004; 13: 215-20)

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Spermatogenesis impairment is the main cause of infertility in men. Androgen is believed to play a critical role in regulating spermatogenesis. Androgen acts by binding to the androgen receptor (AR) which is a protein regulator of DNA transcription. Exon 1 of AR gene contains a CAG repeat length polymorphism and it is believed to interfere AR function. This study includes DNA isolation from peripheral blood and amplification of CAG repeat fragments by PCR method. CAG repeat lengths were determined by electrophoresis on 6% denaturing gel polyacrylamide. We found that the mean CAG repeat lengths were 24,3 ± 3,4 in oligozoospermic/azoospermic men and 22,7 ± 2,7 in normozoospermic men. The difference in CAG repeat length between the two groups was statistically significant (p = 0,031, t-test). Nevertheless, there was no correlation between CAG repeat lengths and sperms concentration (rs = -0,038; p = 0,775). This result suggest that the expansion of CAG repeat length was not the main cause of spermatogenesis impairment. (Med J Indones 2004; 13: 215-20)"

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"Latar BelakangAzoospermia, yang dikenal sebagai ketiadaan sperma dalam ejakulasi, adalah penyebab utama infertilitas pria, yang diklasifikasikan menjadi pre-testicular, testicular, dan post- testicular. Penyebab pre-testicular dan post-testicular memungkinkan intervensi kesuburan, sementara penyebab testicular bersifat ireversibel dengan tingkat keberhasilan yang lebih rendah. Indonesia memiliki keterbatasan data yang mendukung dokter dalam menentukan tingkat keberhasilan pengambilan sperma berdasarkan etiologi yang berbeda. Dokter dapat memperoleh manfaat dengan mengetahui klasifikasi penyebab azoospermia dan bagaimana hal tersebut memengaruhi tingkat keberhasilan pengambilan sperma. Studi ini bertujuan untuk menyelidiki hubungan antara etiologi azoospermia dan tingkat keberhasilan pengambilan sperma.MetodeKami melakukan analisis cross-sectional terhadap data dari rumah sakit di Jakarta. Data mencakup 659 pasien azoospermia yang telah menjalani prosedur pengambilan sperma. Etiologi azoospermia dikategorikan menjadi pre-testicular, testicular, dan post-testicular. Data dengan dua atau lebih etiologi simultan dianggap sebagai azoospermia multi- faktorial. Namun, azoospermia multi-faktorial dikecualikan dari analisis. Uji chi-square digunakan untuk menganalisis hubungan antara etiologi azoospermia dan tingkat keberhasilan pengambilan sperma. Asosiasi antara metode pengambilan sperma dengan tingkat keberhasilan pengambilan sperma juga dianalisis dengan uji chi-square. Penelitian ini telah memperoleh izin etik.HasilData terdiri dari 111 pasien azoospermia pre-testicular, 112 pasien azoospermia testicular, 62 pasien azoospermia post-testicular, dan 374 pasien azoospermia multi-faktorial. Analisis chi-square menunjukkan adanya hubungan yang signifikan antara etiologi azoospermia dan tingkat keberhasilan pengambilan sperma (χ2 = 134.179, p = <0.001). Azoospermia post-testicular memiliki tingkat keberhasilan pengambilan sperma tertinggi (97.1%), diikuti oleh azoospermia testicular (27.7%) dan azoospermia pre-testicular (13.2%). Selain itu, analisis metode pengambilan sperma menunjukkan perbedaan tingkat keberhasilan yang signifikan. PESA memiliki tingkat keberhasilan tertinggi sebesar 94% (234/249. TESE menunjukkan tingkat keberhasilan terendah sebesar 19.4% (78/402). Hubungan yang signifikan antara metode pengambilan sperma dan hasil juga ditemukan.KesimpulanStudi kami menemukan adanya hubungan signifikan (nilai p < .001) antara etiologi azoospermia dan tingkat keberhasilan pengambilan sperma. Azoospermia pasca- testicular memiliki tingkat keberhasilan tertinggi sebesar 98,4%. Azoospermia pre- testicular merupakan jenis yang paling umum terjadi, diikuti oleh azoospermia testicular dan pasca-testicular. Selain itu, metode pengambilan sperma juga secara signifikan berkaitan dengan tingkat keberhasilan, di mana Percutaneous Epididymal Sperm Aspiration (PESA) menjadi metode yang paling efektif dengan tingkat keberhasilan 94%. Hal ini menegaskan pentingnya pemahaman etiologi dan pemilihan metode pengambilan yang tepat dalam menangani azoospermia.

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Introduction

Azoospermia, known as absence of sperm in ejaculation, is a major cause of male infertility, classified as pre-testicular, testicular, post-testicular. Pre-testicular and post- testicular causes allow for fertility intervention, while testicular causes are irreversible with lower success rates. Indonesia have a data scarcity to support doctors to determine the sperm retrieval success rate between different etiology. Doctors could be benefited by knowing the classifications of the causes for azoospermia and how it affects the sperm retrieval success rate. This study aimed to investigate the associaton between etiology of azoospermia and the success rate of sperm retrieval

Method

We conducted a cross-sectional analysis of data from hospitals in Jakarta. The data includes 659 azoospermia patient who have undergone sperm retrieval procedures. Azoospermia etiology was categorized into pre-testicular, testicular, and post-testicular azoospermia. Data who have two or more simultaneous etiology were considered as multi-factorial azoospermia. However, multi-factorial azoospermia is excluded from the analysis. Chi-square tests were used to analyse the association between etiology of azoospermia and sperm retrieval success rate. Sperm retrieval methods association with sperm retrieval success rate was also analyse with chi-square test. The ethical clearance is obtained for this research.

Results

The data consist of 111 pre-testicular azoospermia patients, 112 testicular azoospermia patients, 62 post-testicular azoospermia patients, and 374 multi-factorial azoospermia patients. Chi-square analysis revealed a significant association between azoospermia etiology and sperm retrieval success rate (χ2= 134.179, p = <.001). Post-testicular azoospermia has the highest sperm retrieval success rate (97.1%), followed by testicular azoospermia (27.7%), and pre-testicular azoospermia (13.2%). In addition, the analysis of sperm retrieval methods showed significant differences in success rates. PESA had the highest success rate at 94% (234/249), TESE demonstrated the lowest success rate at 19.4% (78/402). A significant association between sperm retrieval methods and outcomes was observed.

Conclusion

Our study found a significant association (p-value < .001) between the etiology of azoospermia and the success rate of sperm retrieval. Post-testicular azoospermia exhibits the highest success rate at 98.4%. Pre-testicular azoospermia is the most prevalent type, followed by testicular and then post-testicular azoospermia. Additionally, the method of sperm retrieval is also significantly associated with sperm retrieval success rates, with Percutaneous Epididymal Sperm Aspiration (PESA) proving to be the most effective, boasting a 94% success rate. This underscores the importance of both etiological understanding and the selection of appropriate retrieval methods in treating azoospermia."

"Most of male infertility are caused by defect in sperm motility (asthenozoospermia). The molecular mechanism of low sperm motility in asthenozoospermic patients has not been fully understood. Sperm motility is strongly related to the axoneme structure which is composed of microtubules and supported by outer dense fiber (ODF) and fibrous sheath (FS) protein. The objective of this study was to characterize the ODF (ODF1 and ODF2) expression in asthenozoospermic infertile male and control normozoospermic fertile male. Asthenozoospermic samples (n=18) were collected from infertile patients at andrology lab, Cipto Mangunkusumo Hospital Jakarta and control were taken from normozoospermic fertile donor (n=18). After motility analyses by computer assisted sperm analysis (CASA), semen were divided into two parts, for Western blot and for immunocytochemistry analysis. Antibody against ODF1 and ODF2 protein were used in both analyses. Analysis of ODF1 protein expression showed bands with molecular weight of -30 kDa and ODF2 -85 kDa. The mean band intensity of ODF1 and ODF2 protein were lower in the asthenozoospermic group (AG) compared to normozoospermic group (NG). Moreover, both ODF proteins were less intense and less localized in the AG than NG. Sperm motility was lower in AG, compared to control NG, i.e.average path velocity (VAP) = 32.07 +-7.03 vs 37.58 +-8.73=0.455; straight line velocity (VCL) = 45.68+-7.91 vs 55.55 +-16.40 p=0.099. There is down-regulation of ODF1 and ODF2 protein expression and less-compact localization in AG sperm compared to the NG. These changes might have caused disturbances in the sperm motility as observed in this study."