Sevcan BOZDOĞAN, Ahmet DURSUN, Çetin YEŞİLLİ, İlker SEÇKİNER, Feryal ÇABUK, Korhan ALTAN, Gürdal BOZDOĞAN

Varikoseli olan hastalarda Y kromozomu mikrodelesyonu-infertilite ilişkisi

Giriş: Varikosel hastalarında spermatogenezi etkileyen patolojik faktörler henüz tam olarak aydınlatılamamıştır. Bu hastalarda varikosele eşlik eden testiküler patolojilerin yanı sıra, Y kromozomunun uzun kolunda bulunan mikrodelesyonların da spermatogenezi etkilediği bilinmektedir. Y kromozom mikrodelesyonlarının, oligozoospermi ve azospermiden sorumlu olduğu gösterilmiştir. Bu çalışmada, varikoseli olan hastalarda, Y kromozom mikrodelesyonlarının infertilite gelişimine katkısının araştırılması amaçlanmıştır. Hastalar ve yöntem: Çalışmaya 18’si infertil, 14’ü fertil toplam 32 varikosel hastası dahil edilmiştir. Tüm hastaların spermiogramları yapılmış ve Y kromozomunun Azospermi Faktör-a (AZF-a), Azospermi Faktör-b (AZF-b), Azospermi Faktör-c (AZF-c) bölgeleri mikrodelesyon varlığı açısından değerlendirilmiştir.Bulgular: 3’ü azospermik olmak üzere 18 hastadan oluşan infertil grubun sperm sayısı 0-104 milyon/ml arasında değişmekte iken (ortalama 37.1 milyon/ml) 14 hastadan oluşan fertil grubun sperm sayısı 7.5-192 (ortalama 75.8) milyon/ml arasında bulunmuştur. İnfertil gruptaki hastaların 4’ünde Azospemi Faktör-a ve Azospemi Faktör-b bölgesinde mikrodelesyonlar tespit edilmiş iken fertil grupta Y kromozom mikrodelesyonuna rastlanmamıştır. Y kromozom mikrodelesyonu olan hastaların, birinin azoospermik olmak üzere ortalama sperm sayılarının 24.8 milyon/ml olduğu saptanmıştır. Sonuç: Y kromozomu mikrodelesyonları varikoselli hastalarda da görülebilen ve fertiliteyi etkileyen nedenlerden biridir. Varikoseli olan hastalarda fertilite değerlendirmesi yapılırken, Y kromozom mikrodelesyon olasılığının göz önünde bulundurulması uygun olacaktır. Özellikle post-operatif sperm sayısında artış olmayan varikoselli hastalarda, infertiliteden Y kromozom mikrodelesyonları sorumlu olabilir. Bu şekilde hem infertilite nedeni ortaya konabilecek, hem de varikoselektomi sonrası fertilitenin sağlanması için kullanılacak en uygun yardımcı üreme tekniğinin seçiminde yol gösterici olacaktır.

Anahtar Kelimeler:

Varikosel, Y kromozomu, Kromozom parçası kaybı, Kısırlık

The association of Y chromosome microdeletions and infertility in patients with varicocele

Introduction: The pathological factors cause spermatogenesis arrest in varicocele patients still remain unknown. In these patients, both testiculopathies and Y chromosome long arm deletions affect spermatogenesis. Y chromosome microdeletions are known to be responsible for oligozoospermia and azoospermia. In this study, the relation between Y chromosome microdeletion and infertily in varicocele patients aimed to be investigated. Patients and methods:, Thirty-two varicocele patients (14 fertile and 18 infertile) were included in this study. All patients semen analysis were employed and screening for microdeletions in Azospermia Factor-a (AZF-a), Azospermia Factor-b (AZF-b), Azospermia Factor-c (AZF-c) were performed. Results: The sperm count of infertil group (3 of 18 had azoospermia) was between 0-104 million/ml (mean 37.1 million/ml), fertile group’s sperm count was between 7.5-192 million/ml (mean 75.8 million/ml). While 4 patients of infertil group had Azospermia Factor-a and Azospermia Factor-b microdeletions, no microdeletion was determined in fertile group. The mean sperm count of 4 patients with microdeletion (one azoospermic) were 24.8 million/ml. Conclusion: Y chromosome microdeletion can be found in varicocele patients and one of the reasons of infertility. When evaluate the fertility in varicocele patients, Y chromosome microdeletion suggested to be taken into consideration. Y choromosome microdeletions could be the reason of infertility in patient with varicocele whose sperm count did not increase after operation. Therefore, not only the cause of infertility would be established, but also the appropriate assisted reproductive technologies would be chosen after varicocelectomy.

Keywords:

Varicocele, Y Chromosome, Chromosome Deletion, Infertility,

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