AZOSPERMIA

Azoospermia means the absence of sperm (absence of sperm) in the semen of the man. The problem of azoospermia is seen in approximately 1% of men, and in 10% to 15% of men with infertility problems. It is also important not to confuse azoosperm with oligosperm, which contains a small amount of sperm in the semen. The reason for this is that small amounts of sperm can be used by microinjection. In this way, there is no need to work to provide sperm.

Azoospermia is generally examined in two groups as obstructive and non-obstructive. Occlusion-related azoospermia may occur after congenital absence of a part of sperm ducts, genital infections and surgical interventions. Azospemia that is not related to obstruction may develop due to genetic disorders, congenitally remaining testes in the canals, testicular torsion, some infections and radiation. Some surgical interventions can be tried to open the channels in azoospermia due to obstruction. Surgical sperm retrieval and microinjection is the only treatment method for patients with unsuccessful surgical intervention and for azoospermia not related to obstruction.

What to do in these patients; urology examination, hormone and genetic tests. In addition, some genetic tests are recommended before in vitro fertilization. Since the probability of finding sperm in patients with deletion of the Y-chromosome in AZfa, AZFb or the entire AZF region is very low, it is recommended not to be treated. In patients with chromosome number disorders, we apply genetic diagnosis (PGD) to embryos obtained in in vitro fertilization and give only healthy embryos.

40% of azoospermia is due to obstruction. In these patients, sperm can be obtained by entering the epidymis with a needle (PESA), by entering the epididymis with microsurgery (MESA), by entering the testis with a needle (TESA), and by taking tetsite tissue samples (TESE) for patients who do not have sperm with these methods. Sperm can be found in nearly all patients with obstruction. In patients who have sperm from the epididymis but no motile sperm, sperm should be taken from the testis. Studies have shown that the success rates of microinjection in obstructive azoospermia are not different from patients who can give sperm by masturbation, that is, sperm in the semen.

60% of azoospermias are not due to obstruction. The only way to have a child in these patients is to surgically collect sperm from the testis (micro TESE) and then apply microinjection. Sperm can be obtained surgically in approximately 50-60% of this group of patients. In these patients, sperm is searched first by entering the testis with a needle. If not, sperm can be obtained by surgically taking biopsies from the testis. In order to reduce the trauma to the testis (ovary), first of all, sperm is searched with a needle before the testis is opened. After the testis is opened, tubules are taken from different regions under the microscope and sperm are searched for hours in these samples taken in the Embryology Laboratory.

The effect of testicular volume or hormone levels on the probability of finding sperm is quite limited. Some genetic testing is recommended in azoospermic men who are not due to obstruction. The reason for this is that some genetic disorders are more common in these patients. For example, 10-20% of these patients have somatic chromosome disorders and 5-10% of them have Y-chromosome breaks. Since the chance of surgical sperm retrieval is negligible in the AZFb region of the Y-chromosome or in larger deletions including AZFb, it is not recommended to exclude these patients from treatment.

Micro TESE is the biopsy of the testis under the microscope. The aim here is to enlarge the tissue under the microscope and remove the tissues with a high probability of containing sperm. Therefore, while the probability of finding sperm increases in theory, the damage to the testis decreases as less tissue is taken. Microinjection is performed with the sperm found in the collected material, and the sperm are stored in other observed tissues for use in different trials.