Azospermisi olan İnfertil Erkeğe Yaklaşım

Abstract

Azospermi ejakülat incelemesinde sperm bulunmaması hali olarak tanımlanmaktadır. Azospermi testiste spermatozoa üretiminin olmamasından ya da üretilen spermatozoaların emisyon ile dışarı atılan ejakülata ulaşamamalarından kaynaklanabilir. Azospermi genel olarak obstrüktif ve non-obstrüktif olmak üzere iki grupta değerlendirilmektedir. Pretestiküler nedenler genellikle spermatogenezi etkileyen endokrin bozuklukları içerir, testiküler nedenler primer testis patolojilerini içerir ve posttestiküler nedenler ise obstrüktif patolojileri içerir. Doğru ve kesin bir tanıya ulaşabilmek için, iyi bir ürolojik, hormonal ve genetik değerlendirme yapılmalıdır. Azospermik olgularda tedavi stratejisini altta yatan etiyolojik neden belirler. Eğer ejakülatta sperm görülmesi mümkün ise bu spermlerle, ya da ejakülatta sperm görülmeyen olgularda girişimsel sperm elde etme teknikleri ile elde edilen spermlerle, yardımcı üreme teknikleri kullanılarak gebelik elde edilmesi amaçlanmaktadır. Azospermi etiyolojisi iyi anlaşılıp, tedavi yöntemleri geliştikçe, hem ejakülatta sperm görülme oranları hem de girişimsel metotlarla sperm elde edilme oranları artacak, bu sayede gebelik elde edebilme olasılığının da daha yüksek olacağı düşünülmektedir. İnsan üzerinde başlayan gen terapilerinde ve mezenkimal kök hücre çalışmalarında önemli gelişmeler kaydedilmesi nedeniyle yakın gelecekte azospermi tedavisinde de önemli gelişmelerin olabileceği düşünülmektedir.

Keywords

• Azospermi
• infertilite
• tanı
• tedavi

Management of the Infertile Male with Azoospermia

Abstract

Azoospermia means the complete absence of spermatozoa upon examination of the semen. Azoospermia may result from a lack of spermatozoa production in the testicles, or from an inability of produced spermatozoa to reach the emitted semen. Azoospermia is generally examined in two groups as obstructive and non-obstructive. Pretesticular causes usually include endocrine disorders that affect spermatogenesis, testicular causes include primary testicular pathologies, and posttesticular causes include obstructive pathologies. In order to make the exact diagnosis, a good urological, hormonal and genetic evaluation is required. The underlying etiologic cause determines the treatment strategy in azoospermic cases. If it is possible to see sperm in the ejaculate, pregnancy is tried to be achieved with ejaculate sperm, if not, with the spermatozoa obtained by interventional methods, by using assisted reproductive techniques. As the etiology of azoospermia is understood and treatment methods are improved, it is thought the rate of obtaining sperm both in the ejaculate and with interventional methods will increase, and as a result, higher pregnancy rates should be achieved. It is thought that there will be important developments in the treatment of azoospermia in the near future, as there have been significant advances in gene therapies and mesenchymal stem cell studies started on humans.

Keywords

• Azoospermia
• infertility
• diagnosis
• treatment

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