The association between etiology of azoospermia and sperm retrieval success rate on male patient in Indonesia: a multi-centre study.

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.