https://doi.org/10.4081/aiua.2026.14921
The association between etiology of azoospermia and sperm retrieval success rate on male patient in Indonesia: a multi-centre study
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 7 August 2026
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. The aim of the study is to investigate the association between etiology of azoospermia and the success rate of sperm retrieval as well as the association between sperm retrieval methods utilized with the sperm retrieval success rate.
Methods: We conducted a cross-sectional analysis of medical records from one public and two private hospitals in Jakarta. The data includes azoospermia patients who have undergone sperm retrieval procedures since 2009 until 2024. Azoospermia etiology was categorized into pre-testicular, testicular, and posttesticular azoospermia. Multi-factorial azoospermia (has two or more simultaneous etiology) was 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 analysed with chi-square test.
Results: The study included 659 patients consisting of 111 (16.9%) pre-testicular azoospermia patients, 112 (17.1%) testicular azoospermia patients, 62 (9.4.%) post-testicular azoospermia patients, and 374 (56.6%) multi-factorial azoospermia patients. There was a significant association between azoospermia etiology and sperm retrieval success rate (p = <.001). Posttesticular azoospermia has the highest sperm retrieval success rate (97.1%), followed by testicular azoospermia (27.7%), and pre-testicular azoospermia (13.2%). In addition, Percutaneous Epididymal Sperm Aspiration had the highest success rate at 94% (234/249) and TESE demonstrated the lowest success rate at 19.4% (78/402). A significant association between sperm retrieval methods and outcomes was observed.
Conclusions: This study demonstrates that azoospermia etiology significantly influences sperm retrieval outcomes, with post-testicular azoospermia showing the most favorable results. These findings emphasize the importance of accurate etiological assessment to guide clinical decision-making, optimize patient counseling, and improve fertility management in azoospermic patients.
Downloads
1. Sharma M, Leslie S. Azoospermia. StatPearls. 2023.
2. Association MIBPPCotAU, Medicine PCotASfR. Report on management of obstructive azoospermia. Fertil. Steril. 2004; 82:137-41. DOI: https://doi.org/10.1016/j.fertnstert.2004.05.059
3. Franco G, Misuraca L, Tuderti G. Azoospermia. Clinical Management of Male Infertility: Springer; 2014. p. 41-54. DOI: https://doi.org/10.1007/978-3-319-08503-6_6
4. Cocuzza M, Alvarenga C, Pagani R. The epidemiology and etiology of azoospermia. Clinics. 2013; 68:15-26. DOI: https://doi.org/10.6061/clinics/2013(Sup01)03
5. Mou L, Wang Y, Li H, et al. A dominant-negative mutation of HSF2 associated with idiopathic azoospermia. Hum Genet. 2013; 132:159-65. DOI: https://doi.org/10.1007/s00439-012-1234-7
6. Cai Z, Zhang J, Xiong J, et al. New insights into the potential mechanisms of spermatogenic failure in patients with idiopathic azoospermia. Mol Hum Reprod. 2020; 26:469-84. DOI: https://doi.org/10.1093/molehr/gaaa033
7. Leung A, Mira J, Hsiao W. Updates on sperm retrieval techniques. Transl Androl Urol. 2014; 3:94.
8. Vicari E, Grazioso C, Burrello N, et al. Epididymal and testicular sperm retrieval in azoospermic patients and the outcome of intracytoplasmic sperm injection in relation to the etiology of azoospermia. Fertil Steril. 2001; 75:215-6. DOI: https://doi.org/10.1016/S0015-0282(00)01647-2
9. Jarvi K, Lo K, Grober E, et al. The workup and management of azoospermic males. Can Urol Ass J. 2015; 9:229. DOI: https://doi.org/10.5489/cuaj.3209
10. Pantke P, Diemer T, Marconi M, et al. Testicular sperm retrieval in azoospermic men. Eur Urol Suppl. 2008; 7:703-14. DOI: https://doi.org/10.1016/j.eursup.2008.07.006
11. Naredi N, Agrawal A. Testicular Sperm Extraction: Can we Combat Both Obstructive and Non Obstructive Azoospermia. Endocrinol Metab Syndr. 2016; 5:2161-1017.1000218. DOI: https://doi.org/10.4172/2161-1017.1000218
12. Sajadi H, Hosseini J, Farrahi F, et al. Varicocelectomy may improve results for sperm retrieval and pregnancy rate in nonobstructive azoospermic men. Int J Fertil Steril. 2019; 12:303.
13. Schlegel P. Causes of azoospermia and their management. Reprod Fertil Dev. 2004; 16:561-72. DOI: https://doi.org/10.1071/RD03087
14. Deng C-Y, Liu D-F, Zhao L-M, et al. Development of a predictive model for increasing sperm retrieval success by microdissection testicular sperm extraction in patients with nonobstructive azoospermia. Asian J Androl 2023; 25:598-603. DOI: https://doi.org/10.4103/aja2022111
15. Ananda N, Birowo P. Asosiasi antara etiologi azoospermia dan tingkat keberhasilan pengambilan sperma pada pasien pria [thesis]. Depok: Faculty of Medicine, Universitas Indonesia; 2025
Ethics Approval
CRediT authorship contribution
Conception and design of the study: Nadhif Ananda, Ponco Birowo; Data collection: Ponco Birowo, Armand Achmadsyah, Favian Rahmat, Missy Savira; Data analysis: Nadhif Ananda, Indah Widyahening; Drafing manuscript: Nadhif Ananda; Review and editing by: Nadhif Ananda, Ponco Birowo, Armand Achmadsyah, Favian Rahmat. All authors have read and approved the final manuscript.
Supporting Agencies
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.