Ayla SARGIN ORUÇ, Cavidan GÜLERMAN, Tuğba ZEYREK, Nafiye YILMAZ, Hasan Ali İNAL, Deniz TUZCUOĞLU, Nedim ÇİÇEK

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

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

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

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.

Keywords:

male infertility, in vitro fertilization, environmental hazards,

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