Nonobstrüktif Azospermi Olgularında Yeni Yaklaşımlar

Azospermi semende hic sperm bulunamamasi durumudur. Obstruktif ve nonobstruktif olmak uzere iki kategoriye ayrilir. Azospermi tanisi alan hastalardan elde edilen spermatozoayla, ilk gebelik ICSI islemiyle 1993 yilinda olusmustur. Obstruktif azospermi olgularinda sperm bulma sansi daha yuksek olmasina karsin, erkek infertilitesinin en siddetli formu olan nonobstruktif azospermide ise bu oran yaklasik olarak %40-50 araligindadir. Yapilan mikro TESE islemiyle testiste immatur germ hucreleri bulunursa ROSI islemi yapilir ya da in vitro kulturlerle bu hucreler farklilastirilmaya calisilir. Matur germ hucresi bulunamayan bir mikroTESE sonrasinda, hormon replasmani veya ilac tedavileriyle spermatozoalarin elde edilmesi hedeflenir. Son yillara kadar testislerde varliklari bilinen spermatogoniumlara (sperm kok hucresi) ek olarak,  yeni kesfedilen VSEL (very small embriyonic-like stem cell) kok hucrelerinin gosterilmesi tedavi yonundeki umutlari daha da artirmistir. Bunlardan baska deneysel olarak, hucre kulturleri, seminifer tubul kulturleri, organ kulturleri, testikuler organoidler, gen tedavileri ve kok hucre bazli tedavilerin etkinligi gosterilmistir. Insan uzerinde baslayan gen terapilerinde ve mezenkimal kok hucre calismalarinda, onemli ilerlemeler olmasi nedeniyle yakin bir zamanda azospermi tedavisinde de onemli gelismeler olacagi dusunulmektedir.  Anahtar kelimeler:  immatur germ hucreleri, maturasyon arresti, ROSI, fertilizasyon, in vitro kultur. New Approaches in Nonobstructive Azoopermia Cases Abstract 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 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, ROSI 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. Keywords: immature germ cells, maturation arrest, ROSI, fertilization, in vitro culture