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About half of couples who cannot have children have problems with men. There is still no clear information as to why most problems with sperm count or quality originate. Bahçeci Health Group Urology Specialist Op.Dr. Emre Bakircioglu answered the questions about the most common problems, treatment methods, TESE and Micro TESE in men who cannot have children.
What are the causes of male infertility?
Causes of male infertility; the diseases that the man has at a child's age, a history of undescended testes, and disorders due to dilatation of the vessels leading to the testicle called the varicocele, which is an anatomical disorder. To a lesser extent, there are disorders in the hormones responsible for sperm production (problems) and genetic problems. Klinefelter Syndrome is the most common chromosomal disorder.
Is it possible to treat male infertility with medication?
In the 'Hipogonadism' patient group, which constitutes only a part of the men with infertility problems, sperm can be extracted by drug treatment. These men 'Azoospermia' in the case of the absence of the so-called sperm output in case of drug treatment can be achieved sperm output. This condition may be congenital or subsequently developed, the lack of hormone secretion affects sperm production. Azoospermic males in this group are the only cases of inability to have children that can be treated with medication and have good results.
Is medication new?
Drug treatment is a method applied from past to present. However, it is not possible to obtain positive results when not administered in sufficient doses and time. These patients should continue their medication for at least one year. While it was thought that it was almost impossible for the men in this group who had used medication for 3-4 months in the past and who were not followed up well, it was almost impossible to have children, and when this period was increased to at least 1 year, a large part of the sperm was extracted from semen. Some of the patients in this group are able to conceive even naturally. If these couples are not supported during the treatment process and fail due to short-term treatment; he is hopeless, believes that they cannot be cured. What is important here is to instill confidence in patients and to regulate their medications at appropriate doses and to check them regularly.
How can those who cannot conceive naturally have children after treatment?
At the end of the treatment, some patients naturally have children, while the sperm count and quality of some do not reach levels sufficient to have children naturally. In this case, microinjection treatment is recommended instead of waiting. Pregnancy can be achieved as a result of microinjection.
Can medication be effective in men without sperm output due to other causes?
In particular, there is another group of men who underwent surgery (TESE) and without sperm output. Men in this group have the chance to find sperm by half the operation with the operation technique called micro TESE. Since hormone levels are normal and often higher than normal, it is not possible to increase sperm production with drugs in these men. A new method for obtaining sperm in men who cannot find sperm in testicular tissue by micro TESE operation has not been developed yet. If some testosterone levels are low in some men, drug therapy can be used to raise them 2-3 months before the operation.
Is azoospermia a common condition? How often is the Micro TESE method applied?
The absence of azoospermia, that is, sperm retrieval, is a 10-15% occurrence in male infertility. It may be due to obstruction or production defect. Micro TESE operation is the only solution for men who have sperm production disorder and cannot be treated with medication. This is because sperms obtained from testicular tissues can be transferred to the eggs of their spouses by microinjection and embryo development and pregnancy can be achieved successfully. Micro TESE method was first introduced in 1999 in the USA. Since 2002, in our country, this operation has been performed to find sperm in men due to production disorder.
How to distinguish azoospermic men with the highest chances and the least chances?
In general, the success of finding sperm is around 50%. To explain; for example, if men with undescended testes undergo an operation before the age of puberty and testicular size is good, there is a chance of finding sperm at a rate of 65-70%. Even in men who had no chance of chromosome structure disorder in the past, sperm retrieval rate was increased with this new technique. 'Klinefelter Syndrome' in the study of men with congenital chromosome structure disorder in the study found that the probability of finding sperm is related to age. Therefore, it was found that micro TESE method was performed in young men with Klinefelter syndrome when the chance of finding sperm increased. It was also seen that sperm finding and pregnancy rates were at the same level as men with normal chromosome structure. Therefore, the examinations of azoospermic men should be performed and evaluated. In addition, the use of a microscope in the operation of some azoospermic men significantly increases the chance of finding sperm in the testicular tissue and continues to have the chance to have children with IVF methods.