Publication: Marmara Üniversitesi Tıp Fakültesi Androloji Bilim Dalının erkek infertilitesi konusunda son 5 yıldaki deneyimi
Abstract
Amaç Bu çalışmanın amacı Marmara Üniversitesi Tıp Fakültesi Androloji Bilim Dalı infertilite polikliniği’ne başvuran hastaları son 5 yılda konulan tanı ve uygulanan tedaviler ilgili literatür ışığında retrospektif olarak incelemektir. Gereç-Yöntem Androloji - İnfertilite polikliniğine Mart 2006 ve Haziran 2010 tarihleri arasında başvuran 471 primer ve 42 sekonder infertilite tanısı alan, toplam 513 hastanın dosyaları retrospektif olarak incelendi. Marmara Üniversitesi Tıp Fakültesi (MÜTF) Üroloji AD İnfertilite inceleme formu kullanılarak her hastadan detaylı öyküleri alınarak fizik incelemeleri yapıldı. Hastalar 2 hafta ara ile en az 2 kez yapılmış spermiyogram testleri ve hormon profillleri ile değerlendirildi. Azoospermik ve ileri derecede oligo-astenoteratospermik hastalar karyotip analizi ile incelendi. Hastalar düzeltilebilir erkek faktörü olmayan ve yardımcı üreme tekniğine yönlendirilenler, non-obstrüktif azospermi tanısı ile Testiküler Sperm Ekstrasyonu (TESE) uygulananlar, sperm parametreleri bozuk varikoselli olup operasyon uygulananlar ve hormon profilinde bozukluk saptanıp medikal tedavi alanlar olarak gruplandırıldı. Tüm veriler SPSS 15,0 programına kayıt edilerek başvuru yaşları, eş yaşları, infertilite süre ortalamaları hesaplandı. Medikal özgeçmişlerinde, kullandıkları ilaçlar, geçirilmiş genitoüriner sistem infeksiyonları, geçirilmiş ürolojik operasyonlar kaydedildi. Bunların sonucunda erkek infertilitesi ile başvuran hastalar nedene yönelik gruplandırılarak tedavi şekli ve seçenekleri belirlendi. YÜT, TESE, TUR-ED ya da varikoselektomi yapılmış olan hastaların sayısı ve sonuçları tespit edilip başarı oranları literatür eşliğinde diğer mevcut çalışmalar ile karşılaştırıldı. BULGULAR Kliniğimizde değerlendirilip fizik incelemede varikosel saptanan 25 hastaya sol, 16 hastaya bilateral olmak üzere 41 hastaya mikroskopik varikoselektomi operasyonu uygulandı. Opere edilen 41 hastanın postoperatif dönem izleminde 10 ‘unun (% 35) eşlerinde ortalama postoperatif 6,1 ayda spontan gebelik görüldüğü (min:1 ay - max:12 ay), 2 hastada YÜT ile gebelik sağlandığı, 13 hastada fertilite olmadığı, 3 hastada belirlenen operasyon tarihinden önce spontan gebelik geliştiği öğrenildi. Kırkbir hastadan 6’ sı takip dışı kaldı. Nonobstrüktif Azospermi nedeni ile Mikroskopik TESE uygulanan 76 hastanın 34’ünde sperm bulunurken (% 45), sperm bulunan azoospermik hastalar ile bulunamayan hastalar karşılaştırıldığında FSH değerinin düşük olduğu hasta grubunda sperm bulma oranı daha yüksek bulunmuş (p<0.05) olup istatistiksel olarak anlamlı kabul edilmiştir (Mann – Whitney Test ). Hastalar ED açısında IIEF-5 form ile değerlendirildi. IIEF-5 skoru, azoospermik ve şiddetli oligospermik olan hastalarda, sperm sayısı >1 milyon olan hastalara göre daha düşük saptanmış olup istatistiksel olarak anlamlı bulunmuştur (p:0.04). SONUÇ Erkek faktörü infertilite değerlendirmesi sistematik bir süreçtir. Düzeltilebilir erkek faktörü olan olgular gerek spontan yolla gerek YÜT yardımı ile çocuk sahibi olabilirler. Uygun olgu seçimi tedavinin başarısında anahtar noktadır. gospermi, azospermi, İleri oligoastenoteratozoospermi, erkek infertilitesi, idiyopatik infertilite, varikosel, orşiyopeksi, sito-genetik anormallikler, TESE, sigara ve fertilite
ÖZET ABSTRACT Purpose The aim of the present study is to retrospectively review the diagnosis and treatments of patients admitting to outpatient infertility clinic in the Department of Urology at Marmara University School of Medicine, under the light of current literature. Materials and Methods Between March 2006 and June 2010 the charts of 513 patients were reviewed, retrospectively. Four-hundered seventy-one patients were evaluated for primary infertility and 42 for secondary infertility in the outpatient clinic of infertility. Each of these patients was asked to fill out “the Marmara University Medical Faculty Urology Department Infertility Evaluation Form”. Every patient underwent a physical examination and reviewed for medical history, particularly for infertility. Patients were evaluated with hormone profiles and two semen analysis in at least 2 weeks interval. Patients with azoospermia or severe oligozoospermia were asked to go for a karyotype analysis. Patients were re-grouped into; idiopathic male infertility patients applied for assisted reproductive techniques (ART), non-obstructive azoospermia patients underwent a testicular sperm extraction (TESE), patients with atypical semen analysis underwent a varicocelectomy, patients with atypical hormonal parameters underwent a medical treatment. All data is analyzed with SPSS 15.0. The admission age, partner age and infertile periods are calculated with their means. Patients’ medical histories were detailed for drug use, previous genitourinary infections and previous operations. Further regrouping of male infertility was done according to these etiological facts and treatment type and options of each patient were determined. The number of ART, TESE, TUR-ED, varicocelectomy performed patients and their outcome were assessed with equivalent literature. Results A total of 41 patients had micro-varicocelectomy operation on either left side (n=25) or bilateral (n=16) after physical evaluation. Ten couples (% 35) who underwent varicocelectomy had live child birth in postoperative mean 6.1 months (min: 1 month – max: 12 months). Two couples had fertility by ART, 3 couples had fertility before the date of varicocelectomy, 6 patients were lost to follow up. Among the 76 nonobstructive azoospermia patients, 34 were succeeded in sperm retrieval (% 45). Of these patients, the ones with a lower FSH level seemed to have a statistically significant higher sperm retrieval rate than the others (p<0.05) (The Mann-Whitney test). The patients were evaluated for ED with IIEF-5 form. IIEF-5 score was found to be lower in azoospermia and severe oligospermia patients compared to the patients with a sperm count of > 1 million and this was statistically significant (p:0.04). Conclusion The evaluation male factor in infertility should be a systematic process. Patients with manageable male risk factors can have a child either with spontaneous pregnancy or with the help of ART. Proper case selection is the key to successful treatment. gospermia, azoospermia, severe oligoasthenoteratospermia, male infertility, idiopathic infertility, varicocele, orchidopexy, cito-genethic abnormalities, testicular sperm extraction, smoke and fertility
ÖZET ABSTRACT Purpose The aim of the present study is to retrospectively review the diagnosis and treatments of patients admitting to outpatient infertility clinic in the Department of Urology at Marmara University School of Medicine, under the light of current literature. Materials and Methods Between March 2006 and June 2010 the charts of 513 patients were reviewed, retrospectively. Four-hundered seventy-one patients were evaluated for primary infertility and 42 for secondary infertility in the outpatient clinic of infertility. Each of these patients was asked to fill out “the Marmara University Medical Faculty Urology Department Infertility Evaluation Form”. Every patient underwent a physical examination and reviewed for medical history, particularly for infertility. Patients were evaluated with hormone profiles and two semen analysis in at least 2 weeks interval. Patients with azoospermia or severe oligozoospermia were asked to go for a karyotype analysis. Patients were re-grouped into; idiopathic male infertility patients applied for assisted reproductive techniques (ART), non-obstructive azoospermia patients underwent a testicular sperm extraction (TESE), patients with atypical semen analysis underwent a varicocelectomy, patients with atypical hormonal parameters underwent a medical treatment. All data is analyzed with SPSS 15.0. The admission age, partner age and infertile periods are calculated with their means. Patients’ medical histories were detailed for drug use, previous genitourinary infections and previous operations. Further regrouping of male infertility was done according to these etiological facts and treatment type and options of each patient were determined. The number of ART, TESE, TUR-ED, varicocelectomy performed patients and their outcome were assessed with equivalent literature. Results A total of 41 patients had micro-varicocelectomy operation on either left side (n=25) or bilateral (n=16) after physical evaluation. Ten couples (% 35) who underwent varicocelectomy had live child birth in postoperative mean 6.1 months (min: 1 month – max: 12 months). Two couples had fertility by ART, 3 couples had fertility before the date of varicocelectomy, 6 patients were lost to follow up. Among the 76 nonobstructive azoospermia patients, 34 were succeeded in sperm retrieval (% 45). Of these patients, the ones with a lower FSH level seemed to have a statistically significant higher sperm retrieval rate than the others (p<0.05) (The Mann-Whitney test). The patients were evaluated for ED with IIEF-5 form. IIEF-5 score was found to be lower in azoospermia and severe oligospermia patients compared to the patients with a sperm count of > 1 million and this was statistically significant (p:0.04). Conclusion The evaluation male factor in infertility should be a systematic process. Patients with manageable male risk factors can have a child either with spontaneous pregnancy or with the help of ART. Proper case selection is the key to successful treatment. gospermia, azoospermia, severe oligoasthenoteratospermia, male infertility, idiopathic infertility, varicocele, orchidopexy, cito-genethic abnormalities, testicular sperm extraction, smoke and fertility