Mario Alexander, Gito Restiansyah Wasian, Mira Krishtania, Basaria Sinurat, Irene Qitta, Geraldo Laurus, Kamelissha Faadhilah, Kelby Lesmana

Evaluasi hemizona index sebagai parameter fungsi sperma untuk keberhasilan inseminasi intrauterin

Introduction

Evaluasi hemizona index sebagai parameter fungsi sperma untuk keberhasilan inseminasi intrauterin. Evaluasi peran Hemizona Index (HZI) & Total Motile Sperm Count (TMSC) dalam memprediksi keberhasilan inseminasi intrauterin (IUI). Kombinasi ini tingkatkan akurasi prediksi.

Abstract

Background: Intrauterine insemination (IUI) is frequently employed as a treatment for infertility, yet its clinical pregnancy rate remains relatively modest. The total motile sperm count (TMSC) has traditionally served as a predictor of IUI success, although its consistency is debatable. The hemizona index (HZI) has been introduced as an additional parameter that evaluates sperm binding capacity to the zona pellucida, reflecting an essential step of fertilization. This study aimed to assess the predictive role of HZI and TMSC in IUI outcomes. Methods: A retrospective descriptive study with a quantitative approach was conducted on patients who underwent both HZI and TMSC testing in conjunction with IUI procedures at Bocah Indonesia Fertility Center between August 2021 and June 2025. Data included HZI values, TMSC, and pregnancy outcomes assessed by qualitative urine β-hCG testing. Results: Among 112 couples, clinical pregnancy was more frequent in the HZI ≥30% group compared to HZI <30% (20% vs. 4.5%). A parallel trend was observed in TMSC, where patients with TMSC >10 million achieved a pregnancy rate of 19.1%, nearly double compared to 8.7% in the ≤10 million group. The highest success rate (21.3%) was observed when HZI ≥30% was combined with TMSC >10 million, while no pregnancies occurred in the lowest category (HZI <30% and TMSC ≤10 million). Conclusion: HZI provides functional insight into sperm capacity beyond traditional quantitative measures. When integrated with TMSC, it enhances predictive accuracy for IUI success. This combined approach may facilitate more individualized fertility counseling and therapeutic decision-making from the outset. Latar Belakang: Inseminasi intrauterin (IUI) merupakan terapi yang banyak digunakan pada kasus infertilitas, namun tingkat kehamilan yang dihasilkan masih relatif rendah. Total motile sperm count (TMSC) lazim digunakan sebagai prediktor keberhasilan, meskipun hasil penelitian menunjukkan variasi. Hemizona index (HZI) diperkenalkan sebagai parameter tambahan yang menilai kemampuan sperma berikatan dengan zona pelusida sebagai tahap penting fertilisasi. Penelitian ini bertujuan mengevaluasi peran prediktif HZI dan TMSC terhadap keberhasilan IUI. Metode: Studi deskriptif retrospektif dengan pendekatan kuantitatif dilakukan pada pasien yang menjalani uji HZI dan TMSC serta prosedur IUI di Pusat Fertilitas Bocah Indonesia periode Agustus 2021–Juni 2025. Data mencakup nilai HZI, TMSC, serta status kehamilan berdasarkan pemeriksaan β-hCG kualitatif urin. Hasil: Dari 112 pasangan, kelompok dengan HZI ≥30% menunjukkan tingkat kehamilan lebih tinggi dibandingkan HZI <30% (20% vs. 4,5%). Tren serupa terlihat pada TMSC, di mana kelompok >10 juta mencatat keberhasilan 19,1% dibandingkan 8,7% pada kelompok ≤10 juta. Kombinasi HZI ≥30% dan TMSC >10 juta memberikan angka keberhasilan tertinggi (21,3%), sedangkan tidak terdapat kehamilan pada kelompok dengan HZI <30% dan TMSC ≤10 juta. Kesimpulan: HZI memberikan informasi fungsional mengenai kemampuan sperma yang tidak ditangkap oleh parameter kuantitatif semata. Integrasi HZI dengan TMSC meningkatkan ketepatan prediksi keberhasilan IUI, sehingga dapat menjadi dasar pertimbangan dalam konseling fertilitas dan pemilihan terapi sejak awal.

Review

This study presents a timely and important investigation into enhancing the predictability of intrauterine insemination (IUI) outcomes by integrating the hemizona index (HZI) with the total motile sperm count (TMSC). Given the modest success rates of IUI and the inconsistent predictive power of TMSC alone, the introduction of HZI as a functional parameter assessing sperm-zona pellucida binding capacity is a significant development. The retrospective descriptive study, involving 112 couples, found that both HZI ≥30% and TMSC >10 million were independently associated with higher clinical pregnancy rates. Crucially, the combination of optimal HZI and TMSC values yielded the highest success rate of 21.3%, while the lowest combined category showed no pregnancies. These findings strongly suggest that HZI offers valuable functional insights beyond traditional quantitative measures, and its integration with TMSC can substantially improve the accuracy of IUI success prediction. The primary strength of this research lies in its novel approach to combining a functional sperm assessment (HZI) with a conventional quantitative measure (TMSC) to provide a more comprehensive and accurate prediction model for IUI success. By demonstrating the synergistic effect of these two parameters, the study moves beyond simplistic analyses and offers a more nuanced understanding of sperm quality. This integrated approach has clear practical implications, enabling more individualized fertility counseling for couples considering IUI. Clinicians could potentially use this combined metric to better stratify patients, guiding therapeutic decision-making by identifying couples who are more likely to benefit from IUI versus those who might be better served by more advanced reproductive technologies from the outset. Despite its valuable contributions, the study possesses several limitations that warrant consideration. As a retrospective descriptive study, it inherently lacks the ability to establish causality and is susceptible to selection bias and confounding factors not accounted for in the design. The outcome measure, qualitative urine β-hCG testing, while indicative of biochemical pregnancy, is less robust than clinical pregnancy confirmed by ultrasound with a fetal heartbeat, which could potentially inflate reported success rates or misrepresent true clinical viability. Furthermore, the study was conducted at a single fertility center, which limits the generalizability of its findings to diverse populations and clinical settings. Future research should prioritize prospective, larger-scale, multi-center studies with rigorous control for confounding variables (e.g., female age, etiology of infertility, ovarian stimulation protocols) and utilize confirmed clinical pregnancy and live birth rates as primary outcomes. Investigating the cost-effectiveness of routine HZI testing and establishing specific cutoff values across different patient demographics would also enhance its clinical utility.

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