MALE INFERTILITY IS INCREASING: EVALUATION OF INDICATIONS FOR IN VITRO FERTILIZATION IN A PUBLIC INSTITUTION IN TURKEY

Yıl 2012, Cilt: 9 Sayı: 36, 1478 - 1482, 01.10.2012

Ayla Sargın Oruç Cavidan Gülerman Tuğba Zeyrek Nafiye Yılmaz Hasan Ali İnal Deniz Tuzcuoğlu Nedim Çiçek

Öz

Aim: Malefactor infertility underlies approximately 30% of couples seeking infertility treatment, 10% of which is azoospermia. Recently, we observed an increase in male infertility and investigated the part of male infertility among the in vitro fertilization IVF / intracytoplasmic sperm injection ICSI cycles in a public instutition in Ankara, Turkey. Materials And Method: We reviewed the indications for IVF cycles between 2007 and 2011. Subgroups of male infertility and cases requiring surgical sperm extractions were determined for the last three years. Possible environmental factors related to male infertility are reviewed. Results: A total of 6806 IVF cycles were evaluated. The percentage of couples undergoing IVF therapy due to male infertility was 42.4 %, 46.9 %, 40.6 % , 39.8 % , 36 % , 46.6 %, 51.9 % respectively for each year from 2005 through 2011. In the last three years, a total of 1349 cycles were done of which 597 44.25 % were treated for male infertility. We found that 416 69.7 % of the cases had severe oligospermia and 181 30.3 % mild . There were 170 cases of azoospermia, 27 obstructive and 163 non obstructive. Surgical retrieval of sperm was possible in 105 of the them by PESA, TESA, PESA or MD TESE. Conclusion: Our data suggests a gradual increase in male infertility in recent years. Identification and elimination of environmental hazards should be the subject of both gynecologists and Public Health Services. Elimination of preventable damages will reduce the cost of assisted reproduction.

Anahtar Kelimeler

male infertility, in vitro fertilization, environmental hazards

ERKEK İNFERTİLİTESİNDE ARTIŞ: TÜRKIYE’DE KAMU KURUMUNDA İN VİTRO FERTİLİZASYON İNDİKASYONLARININ DEĞERLENDİRİLMESİ

Öz

Amaç: Infertilite tedavisi için başvuran çiftlerin yaklaşık %30’undan erkek faktörü sorumludur ve bu vakaların %10’u da azoospermiktir. Son yıllarda, hastanemizin IVF ünitesine erkek infertilitesi nedenli başvurularda bir artış izledik ve IVF-ICSI sikluslarında erkek infertilitesinin sıklığını araştırmayı amaçladık. Gereçler ve Yöntem: Retrospektif olarak 2007-2011 yılları arasında yapılan IVF-ICSI sikluslarında endikasyonların dağılımı incelendi. Son üç yılda erkek faktörü nedeniyle tedaviye alınan hastalar ayrıca incelenerek, erkek infertilitesinin subgrupları ve cerrahi olarak sperm elde edilen hastalar araştırıldı. Erkek infertilitesindeki artışın olası sebepleri değerlendirildi. Bulgular: Toplam 6806 IVF siklusu değerlendirmeye alındı. Erkek faktörü nedeniyle IVF-ICSI yapılan hastaların oranı 2005-2011 arasında her yıl için sırasıyla % 42.4, % 46.9, % 40.6, % 39.8, % 36, % 46.6, % 51.9 olarak bulundu. Son üç yılda ise 597 tanesi % 44.25 erkek faktörü sebepli 1349 IVF-ICSI siklusu yapıldı. Bu vakaların 416 69.7 % tanesi şiddetli, 181 %30.3 tanesi ise hafif erkek infertilitesi idi. Azoospermik vakaların sayısı, 27 obstruktif ve 163 tanesi nonobstrük tif olmak üzere toplam 170’ti. Bu hastaların 105 tanesinde PESA, TESA, PESA veya MD TESE ile sperm elde edildi. Sonuç: Verilerimiz erkek infertilitesinde bir artış yaşan- dığını işaret etmektedir. Çevresel faktörlerin tespiti ve eliminasyonu Jinekoloji ve Halk Sağlığı Birimlerinin işbirliği yapmasını gerektiren bir konudur. Önlenebilir hasarların eliminasyonu Yardımcı Üreme Teknikleri nedenli maliyeti azaltmada da faydalı olacaktır

Anahtar Kelimeler

erkek infertilitesi, in vitro fertilizasyon, çevresel etkenler

Kaynakça

• 1.Trost LW, Nehra A. Guideline-based management of male infertility: Why do we need it? Indian J Urol 2011;27:49-57.
• 2.Johansson M, Hellström AL, Berg M. Severe male infertility after failed ICSI treatment--a phenomenological study of men's experiences. Reprod Health 2011; 4:8-4.
• 3.Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ 1992;12:609-13.
• 4.Swan SH, Elkin EP, Fenster L. The question of declining sperm density revisited: an analysis of 101 studies published 1934-1996.Environ Health Perspect 2000;108: 961–966.
• 5.Huyghe E, Matsuda T, Thonneau P. Increasing incidence of testicular cancer worldwide: a review.J Urol 2003;170:5-11.
• 6.Paulozzi LJ.International trends in rates of hypospadias and cryptorchidism. Environ Health Perspect1999;107:297-302.
• 7.Braga DP, Halpern G, Figueira Rde C, Setti AS, Iaconelli A Jr, Borges E Jr. Food intake and social habits in male patients and its relationship to intracytoplasmic sperm injection outcomes.Fertil Steril 2012;97:53-9.
• 8.Agarwal A, Singh A, Hamada A, Kesari K. Cell phones and male infertility: a review of recent innovations in technology and consequences. Int Braz J Urol 2011;37:432-54
• 9.World Health Organization. Towards more objectivity in diagnosis and management of male fertility. Int J Androl 1997;7(Suppl):1–53.
• 10.Hauser R. The environment and male fertility: recent research on emerging chemicals and semen quality.Semin Reprod Med 2006;24:156-67. Review.
• 11.Rozati R, Reddy PP, Reddanna P, Mujtaba R. Role of environmental estrogens in the deterioration of male factor fertility.Fertil Steril 2002;78:1187-94.
• 12.Jurewicz J, Hanke W, Radwan M, Bonde JP. Environmental factors and semen quality.Int J Occup Med Environ Health 2009;22:305-29.
• 13.Fejes I, Závaczki Z, Koloszár S, Szöllosi J, Daru J, Kovács L, Pál A. Hypothesis: safety of using mobile phones on male infertility. Arch Androl 2007;53:105-6.
• 14.Wdowiak A, Wdowiak L, Wiktor H. Evaluation of the effect of using mobile phones on male fertility. Ann Agric Environ Med 2007;14:169-72.
• 15.Sağlık araştırmaları 2010, Turkish Statistical Institute, Printing Division, Ankara. 2012
• 16.Mitra A, Chakraborty B, Mukhopadhay D, Pal M, Mukherjee S, Banerjee S, Chaudhuri K. Effect of smoking on semen quality, FSH, testosterone level, and CAG repeat length in androgen receptor gene of infertile men in an Indian city. Syst Biol Reprod Med 2012 ;14. [Epub ahead of print]
• 17.Gaur DS, Talekar MS, Pathak VP.Alcohol intake and cigarette smoking: impact of two major lifestyle factors on male fertility. Indian J Pathol Microbiol 2010 Jan-Mar;53:35-40.
• 18.Povey AC, Clyma JA, McNamee R, Moore HD, Baillie H, Pacey AA, Cherry NM; Participating Centres of Chaps-uk. Modifiable and non-modifiable risk factors for poor semen quality: a case-referent study.Hum Reprod 2012 Jun 16. [Epub ahead of print]
• 19.Chohan KR, Badawy SZ. Cigarette smoking impairs sperm bioenergetics. Int Braz J Urol 2010 Jan-Feb;36:60-5.
• 20.Mendiola J, Torres-Cantero AM, Moreno-Grau JM, Ten J, Roca M, Moreno-Grau S, Bernabeu R. Food intake and its relationship with semen quality: a case-control study.Fertil Steril 2009 Mar;91:812-8.