NONOBSTRÜKTİF AZOSPERMİ OLGULARINDA YENİ YAKLAŞIMLAR

Azospermi semende hiç sperm bulunamaması durumudur. Obstrüktif ve nonobstrüktif olmak üzere iki kategoriye ayrılır. Azospermi tanısı alan hastalardanelde edilen spermatozoayla, ilk gebelik ICSI (intrasitoplazmik sperm enjeksiyonu) işlemiyle 1993 yılında oluşmuştur. Obstrüktif azospermi olgularında spermbulma şansı daha yüksek olmasına karşın, erkek infertilitesinin en şiddetli formu olan nonobstrüktif azospermide ise bu oran yaklaşık olarak %40-50 aralığındadır. Yapılan mikroTESE (testiküler sperm ekstraksiyonu) işlemiyle testiste immatür germ hücreleri bulunursa ROSI (round spermatid enjeksiyonu) 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 yönündekiumutları daha da artırmıştır. Bunlardan başka deneysel olarak, hücre kültürleri, seminifer tübül kültürleri, organ kültürleri, testiküler organoidler, gen tedavilerive 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.

APPROACHES IN NONOBSTRUCTIVE AZOOPERMIA CASES

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 (intracytoplasmic sperm injection) 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 (testicular sperm exraction), ROSI (round spermatid injection) 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.

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