Impacts of COVID-19 Pandemic on Three IVF Clinics of Jakarta, Indonesia: A Retrospective Qualitative and Quantitative Study.

BACKGROUND: Corona virus disease-19 (COVID-19) pandemic also led to a reduction or even the suspension of elective health services. These decisions affected in vitro fertilization (IVF) programs worldwide. Therefore, it is essential to map the readiness of IVF clinics in providing safety in this situation and in the future. MATERIALS AND METHODS: This is a retrospective qualitative and quantitative research done in 2021 that involved three IVF clinics of Jakarta, Indonesia. Those three clinics were government-owned, private-owned, and educational and training center. The qualitative data of each clinic's readiness towards COVID-19 was obtained from interviews with the clinics staff. The quantitative data were collected from the clinics patients' number and demographic data from 2019-2021 as well as from COVID-19 databases. Both data sets were analysed descriptively and only for the quantitative analysis Stata version 16 was used. RESULTS: There were changes in the domiciles and number of patients attending the three clinics. The ratio of patients from Jakarta increased while patients from outside Java Island decreased. There was a drop in annual patient numbers in 2020. However, from June 2020 to December 2021, the number of monthly IVF cycles increased significantly by 3.5 cycles per month (P=0.001). There was no association between IVF patients' attendance numbers and COVID-19 cases (P=0.785). One of the clinics had a negative pressure operating theatre, which made them more confident in treating patients with COVID-19 positive and made them even had higher IVF cycles started than the pre-pandemic period. CONCLUSION: Those three clinics are prepared in facing COVID-19, as they complied with government regulations. As the COVID-19 pandemic progressed, the number of patients gradually returned to normal.

Comparison of sperm parameters and DNA fragmentation index between infertile men with infection and vaccines of COVID-19.

Several preventive measures, including vaccination, have been implemented owing to the severe global effect of coronavirus disease 2019 (COVID-19), but there is still limited evidence in the effect of this disease and vaccination against it on male fertility. Therefore, this study is to compare sperm parameters of infertile patients with or without COVID-19 infection and the effect of COVID-19 vaccine types on them. Semen samples of infertile patients were collected consecutively at Universitas Indonesia - Cipto Mangunkusumo Hospital (Jakarta, Indonesia). COVID-19 was diagnosed by rapid antigen or polymerase chain reaction (PCR) tests. Vaccination was performed with three types of vaccine, namely inactivated viral vaccine, messenger RNA (mRNA) vaccine, and viral vector vaccine. Spermatozoa were then analyzed on the World Health Organization recommendations, and DNA fragmentation was assayed with the sperm chromatin dispersion kit. The results showed that the COVID-19 group experienced a significant decrease in sperm concentration and progressive motility (both P < 0.05), but there was no significant change in morphology or sperm DNA fragmentation index (DFI; both P > 0.05). The viral vector vaccine caused a decrease in morphology as well as an increase in DFI compared with the control (both P < 0.05), meanwhile results for those who were vaccinated with the inactivated and mRNA types were not significant compared with the control (both P > 0.05). We conclude that COVID-19 has negative effects on sperm parametes and sperm DNA fragmentation, and we found that the viral vector vaccines affect sperm parameter values and DNA fragmentation negatively. Further studies with a larger population and longer follow-up are needed to confirm the results.

Sperm Na+, K+-ATPase α4 and plasma membrane Ca2+-ATPase (PMCA) 4 regulation in asthenozoospermia.

Asthenozoospermia, which is characterized by reduced motility, is one of the etiologies of male infertility. Its biochemical and functional consequences include altered ATPase activity. This study investigated the activities of Na+, K+-ATPase and Ca2+-ATPase and the expression of Na+, K+-ATPase α4 and PMCA4 isoforms in human sperm of asthenozoospermic infertile men. Nineteen samples from asthenozoospermic infertile couples were examined in this study. Computerized-assisted semen analysis (CASA) was performed, and the enzyme activity was measured based on the ability of ATPase to release organic phosphate from ATP as a substrate. The Na+, K+-ATPase α4 and PMCA4 isoform expression levels were measured by western immunoblotting, whereas the protein distribution was examined by immunocytochemistry. This showed that the Na+, K+-ATPase activity and the Na+, K+-ATPase α4 isoform expression were lower in the asthenozoospermia group than in the normozoospermia group (8.688±1.161 versus 13.851±1.884 µmol Pi/mg protein/h, respectively; p>0.05). In contrast, the Ca2+-ATPase activity was significantly higher in the asthenozoospermia group than in the normozoospermia group (11.154±1.186 versus 2.725±0.545 µmol Pi/mg protein/h, respectively; p<0.05). In comparison, PMCA4 expression in the asthenozoospermia group was lower than in the normozoospermia group (p>0.05). The altered ATPase activity and isoform expression in asthenozoospermia may impair sperm structure and function.

Efficacy and Safety of an Injectable Combination Hormonal Contraceptive for Men.

CONTEXT: The development of a safe and effective reversible method of male contraception is still an unmet need. OBJECTIVE: Evaluation of suppression of spermatogenesis and contraceptive protection by coadministered im injections of progestogen and testosterone. DESIGN: Prospective multicentre study. SETTING: Ten study centers. PARTICIPANTS: Healthy men, aged 18-45 years, and their 18- to 38-year-old female partners, both without known fertility problems. INTERVENTION: Intramuscular injections of 200-mg norethisterone enanthate combined with 1000-mg testosterone undecanoate, administered every 8 weeks. MAIN OUTCOMES MEASURES: Suppression of spermatogenesis by ejaculate analysis, contraceptive protection by pregnancy rate. RESULTS: Of the 320 participants, 95.9 of 100 continuing users (95% confidence interval [CI], 92.8-97.9) suppressed to a sperm concentration less than or equal to 1 million/mL within 24 weeks (Kaplan-Meier method). During the efficacy phase of up to 56 weeks, 4 pregnancies occurred among the partners of the 266 male participants, with the rate of 1.57 per 100 continuing users (95% CI, 0.59-4.14). The cumulative reversibility of suppression of spermatogenesis after 52 weeks of recovery was 94.8 per 100 continuing users (95% CI, 91.5-97.1). The most common adverse events were acne, injection site pain, increased libido, and mood disorders. Following the recommendation of an external safety review committee the recruitment and hormone injections were terminated early. CONCLUSIONS: The study regimen led to near-complete and reversible suppression of spermatogenesis. The contraceptive efficacy was relatively good compared with other reversible methods available for men. The frequencies of mild to moderate mood disorders were relatively high.

Induction of rat germ cell apoptosis by testosterone undecanoate and depot medroxyprogesterone acetate and correlation of apoptotic cells with sperm concentration.

AIM: to investigate the safety and effectiveness of dose TU+DMPA hormones in developing potential male contraceptives. METHODS: suppression of rat sperm concentration through increased apoptotic germ cells by in vivo administration of a long-acting androgen composed of a combination of testosterone undecanoate (TU) and depot medroxyprogesterone acetate (DMPA) was performed. Adult Sprague-Dawley rats received 2.5 mg TU every 6 week and 1.25 mg DMPA every 12 week for 60 week, a regimen known to rapidly reduce testosterone production by the testes and produce azoospermia within 12 week. Sperm concentration data were log transformed before analysis. Results are expressed as the mean±SEM. ANOVA, followed by post hoc test was used to determine differences across time and phase. T test was employed to determine differences between two groups. RESULTS: apoptosis revealed significant increase in apoptotic germ cells (80% when rats were administered with TU+DMPA. Apoptotic germ cells can be found in several spermatogonia (20%), spermatocytes (30%), and spermatids (50%). CONCLUSION: dose TU+DMPA hormones may be a safe and effective way to develop potential male contraceptives.