Basaria Lidya Sinurat, Geraldo Laurus, Irene Qitta Pranindita, Mira Krishtania

Bagian terlewatkan: peran androlog dalam mencapai kehamilan setelah beberapa kali gagal siklus IUI

Introduction

Bagian terlewatkan: peran androlog dalam mencapai kehamilan setelah beberapa kali gagal siklus iui. Androlog berperan vital atasi kegagalan IUI pada infertilitas pria. Terapi medis, optimasi sperma, dan strategi ejakulasi kedua tingkatkan peluang kehamilan setelah IUI berulang.

Abstract

Background: Intrauterine insemination (IUI) is considered a relatively simple, minimally invasive, and cost-effective assisted reproductive technique compared to in vitro fertilization (IVF). However, sperm quality remains a critical determinant of treatment success. The involvement of an andrologist plays a pivotal role in patient evaluation, medical therapy, and individualized sperm preparation strategies to improve the likelihood of conception. The purpose of this case report is to highlight the role of andrologists in optimizing sperm quality in male factor infertility after several failed IUI attempts. Case Report: A 32-year-old couple with a three-year history of primary infertility and three unsuccessful IUI cycles presented for further evaluation. The female partner exhibited no reproductive abnormalities, while the male partner was diagnosed with oligoteratozoospermia with normal hormonal levels (T: 573 ng/ml, FSH: 3.16 mIU/ml, E: 26 pg/ml), bilateral grade II varicocele, and a right epididymal cyst on ultrasound. Following a three-month medical regimen including clomiphene citrate, coenzyme Q10, folic acid, and Tribulus terrestris, semen parameters improved significantly. Although the first post-treatment IUI did not result in pregnancy, the hemizona assay demonstrated favorable fertilization potential. A second IUI cycle utilizing the subsequent ejaculate yielded improved semen quality and achieved a successful pregnancy. Conclusion: This case emphasizes that although IUI is a relatively straightforward procedure, expert evaluation and tailored sperm preparation are essential to maximize success rates. The andrologist’s role, particularly through targeted medical therapy and the application of a second ejaculate strategy, may substantially enhance pregnancy outcomes in cases of male factor infertility. Latar Belakang: Inseminasi intrauterin (IUI) merupakan salah satu teknik reproduksi berbantu yang relatif sederhana, minimal invasif, dan lebih hemat biaya dibandingkan fertilisasi in vitro (IVF). Meskipun demikian, kualitas sperma tetap menjadi faktor penentu yang krusial dalam keberhasilan prosedur. Keterlibatan seorang androlog berperan penting dalam menilai kondisi pasien, memberikan terapi medis yang tepat, serta menentukan strategi preparasi sperma yang sesuai untuk meningkatkan peluang kehamilan. Tujuan penulisan laporan kasus ini adalah untuk menggambarkan peran androlog dalam mengoptimalkan kualitas sperma pada pasien dengan infertilitas faktor pria setelah beberapa kali kegagalan siklus IUI. Laporan Kasus: Pasangan berusia 32 tahun dengan infertilitas primer selama tiga tahun dan tiga kali gagal IUI datang untuk evaluasi. Pemeriksaan menunjukkan istri tanpa kelainan reproduksi, sementara suami mengalami oligoteratozoospermia dengan profil hormonal normal (T: 573 ng/ml, FSH: 3,16 mIU/ml, E: 26 pg/ml), serta varikokel bilateral derajat dua dan kista epididimis dextra berdasarkan USG. Pasien pria kemudian menjalani terapi kombinasi klomifen sitrat, koenzim Q10, asam folat, dan Tribulus terrestris selama tiga bulan yang memperlihatkan perbaikan signifikan pada parameter semen. Meskipun IUI pertama pascaterapi tidak berhasil, uji Hemizona Assay menunjukkan potensi fertilisasi yang baik. IUI kedua dengan penggunaan ejakulasi kedua menghasilkan parameter semen yang lebih baik dan berhasil mencetuskan kehamilan. Kesimpulan: Laporan ini menegaskan bahwa meskipun IUI termasuk prosedur yang sederhana, keterlibatan tenaga ahli, terutama androlog, sangat penting dalam menentukan keberhasilan. Pendekatan individual melalui terapi medis terarah dan strategi preparasi sperma yang tepat, termasuk pemanfaatan ejakulasi kedua, dapat secara signifikan meningkatkan peluang kehamilan, khususnya pada kasus infertilitas faktor pria.

Review

This case report effectively addresses a critical, yet often underemphasized, aspect of assisted reproductive technology: the specialized role of an andrologist in managing male factor infertility, particularly after repeated intrauterine insemination (IUI) failures. The title aptly highlights this "overlooked part," drawing attention to the nuanced contribution of male fertility specialists. By focusing on a real-world scenario of a couple with primary infertility and multiple failed IUI cycles, the paper underscores the importance of a comprehensive male fertility evaluation beyond basic semen analysis, challenging the notion that IUI is a "simple" procedure requiring minimal male partner intervention. The abstract demonstrates several strengths in its presentation. It clearly outlines the initial diagnostic findings in the male partner, including oligoteratozoospermia, bilateral varicocele, and an epididymal cyst, providing a detailed clinical context for the intervention. The subsequent description of the three-month medical regimen, which included clomiphene citrate, coenzyme Q10, folic acid, and *Tribulus terrestris*, alongside the significant improvement in semen parameters, offers valuable practical insights for clinicians. Crucially, the report introduces and emphasizes two key strategies: personalized medical therapy and the innovative use of a "second ejaculate strategy" for the subsequent IUI, which ultimately led to a successful pregnancy. This practical approach, supported by the Hemizona assay result, contributes significantly to understanding how to optimize outcomes in challenging male factor infertility cases. While compelling, as a single case report, the findings are inherently limited in their generalizability. The success of the described intervention, while encouraging, cannot be universally applied without further validation through larger prospective studies or clinical trials. Additionally, the specific contribution of each component within the multi-drug regimen is not delineated, making it challenging to pinpoint the most potent therapeutic agents. Future research could explore the precise mechanisms behind the "second ejaculate strategy" and systematically evaluate its efficacy compared to standard IUI protocols. Nonetheless, this abstract effectively serves as a powerful reminder of the indispensable role of the andrologist and the potential benefits of a holistic, individualized approach to male factor infertility, even in seemingly straightforward ART procedures.

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