Nonobstrüktif Azospermi Olgularında Yeni Yaklaşımlar

Year 2019, , 111 - 116, 04.03.2019

Murat Serkant Ünal , Mehmet Caner Özer

https://doi.org/10.17343/sdutfd.395476

Abstract

Azospermi semende hiç sperm bulunamaması durumudur.
Obstrüktif ve nonobstrüktif olmak üzere iki kategoriye ayrılır. Azospermi
tanısı alan hastalardan elde edilen spermatozoayla, ilk gebelik ICSI işlemiyle
1993 yılında oluşmuştur. Obstrüktif azospermi olgularında sperm bulma şansı
daha yüksek olmasına karşın, erkek infertilitesinin en şiddetli formu olan
nonobstrüktif azospermide ise bu oran yaklaşık olarak %40-50 aralığındadır.
Yapılan mikro TESE işlemiyle testiste immatür germ hücreleri bulunursa ROSI
işlemi yapılır ya da in vitro kültürlerle bu hücreler farklılaştırılmaya çalışılır.
Matür germ hücresi bulunamayan bir mikroTESE sonrasında, hormon replasmanı veya
ilaç tedavileriyle spermatozoaların elde edilmesi hedeflenir.

Son yıllara kadar testislerde varlıkları bilinen
spermatogoniumlara (sperm kök hücresi) ek olarak,  yeni keşfedilen VSEL (very small
embriyonic-like stem cell) kök hücrelerinin gösterilmesi tedavi yönündeki
umutları daha da artırmıştır. Bunlardan başka deneysel olarak, hücre
kültürleri, seminifer tübül kültürleri, organ kültürleri, testiküler
organoidler, gen tedavileri ve kök hücre bazlı tedavilerin etkinliği
gösterilmiştir. İnsan üzerinde başlayan gen terapilerinde ve mezenkimal kök
hücre çalışmalarında, önemli ilerlemeler olması nedeniyle yakın bir zamanda
azospermi tedavisinde de önemli gelişmeler olacağı düşünülmektedir.

 Anahtar kelimeler:  immatür germ hücreleri, maturasyon arresti,
ROSI, fertilizasyon, in vitro kültür.

                    New Approaches in
Nonobstructive Azoopermia Cases

Abstract

Azoospermia is the complete absence of any
sperm in semen.
Azoospermia is
classified as obstructive azoospermia or non-obstructive azoospermia. The first pregnancy occured in 1993
with ICSI operation with spermatozoa obtained from azoospermic patients. While
the chance of successful retrieval of sperm in men with obstructive azoospermia
is high, the sperm retrieval rate in men with non-obstructive azoospermia is
approximately 40-50%. If immature germ cells are found in testis with
microTESE, ROSI treatment is performed or these cells are differentiated by in
vitro cultures. Mature germ cells can not be found after microTESE, obtaining
spermatozoa by hormone replacement or drug therapy is targeted.

In
addition to spermatogoniums, a population of very small embryonic-like stem
cells (VSELs) was identified in testes recently. The demonstration of VSELs  has further increased treatment prospects.
Other than these experientially, cell cultures, seminiferous tubule cultures,
organ cultures, testicular organoids, gene treatments and stem cell-based
treatments have been shown to be efficacious. In humans, gene therapy and
mesenchymal stem cell studies have made significant progress therefore it is
thought that there will be significant developments in the treatment of
azoospermia in the near future.

Keywords: immature germ cells, maturation arrest, ROSI, fertilization,
in vitro culture

Keywords

: immatür germ hücreleri, maturasyon arresti, ROSI, fertilizasyon

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