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Examination of Semen Fructose Levels in Infertile Male Patients

Illustration of Fructose (source: alodokter)

The fructose examination is one of the biochemical tests used to diagnose the cause of male infertility. It is not a routine test, but it is a useful supplemental test to provide information on specific clinical conditions, that is done after routine testing ejaculate analysis. According to World Health Organization (WHO) ejaculate analysis laboratory guidelines 2021, each standard ejaculate analysis test takes about 60 minutes, so the timing to test fructose is extended, which may affect the measurement of the level of fructose in ejaculate. In fact, when fructose is tested in this way, the fructose level obtained will differ from the real fructose level because the fructose in the ejaculate will undergo fructolysis. Nonspecific and sensitive test results will inevitably influence the diagnosis.

Based on the background above, we, consisting of Dr. Hermansyah, Dr. Muhammad Fadhli Abdullah, and dr. Ilhamsyah Ilhamsyah under the guidance of dr. Cennikon Pakpahan, Sp. And, Dr. Reny I’tishom, M.Si., and dr. Supardi, Sp. And. We conducted research to analyze the factors that cause male infertility. Such as the presence of a blocked reproductive tract causing the absence of spermatozoa or the term azoospermia. Semen biochemical examination, especially fructose measurement, can be an additional examination that can be used for this diagnosis in reproductive health.

Examination of fructose is carried out after routine ejaculate analysis, resulting in prolonging the examination time so that it will affect the measurement of fructose level in the ejaculate and the accuracy of the diagnosis. This study aims to determine the best timing and procedure for measurement of fructose using a semiautomatic method.

This research is an analytic observational study conducted at Dr. Soetomo General Hospital, Surabaya. A total of 13 ejaculate samples from infertile male patients who met the inclusion criteria were evaluated. Each ejaculate was divided into eight aliquots that were examined for fructose using a semiautomated method after different intervals of time and centrifugation modalities.

This study showed a significant difference in fructose levels when aliquots were centrifuged and examined immediately or after different interval of time (p = 0.036). In addition, aliquots left standing for more than 60 minutes (p = 0.012) and120 minutes (p < 0.001) before centrifugation, showed significantly lower levels compared to aliquots that were centrifuged and then immediately examined.

We suggest that measuring fructose immediately after centrifugation is more reliable than measuring fructose left standing before or after centrifugation. Leaving the ejaculate standing will reduce the fructose level so that it does not resemble its real level.

Author: Dr. Reny I’tishom, S.Pi., M.Si.

Article title: Examination of ejaculate fructose levels on male infertility patients at various times and centrifugation using semiautomatic method

Article Link: https://pagepressjournals.org/index.php/aiua/article/view/12186