What is azoospermia?
It is the absence of sperm cells in the semen. This condition is detected in approximately 10% of patients who consult a doctor due to male infertility.
What are the causes of azoospermia?
Azoospermia is generally examined in two groups. The first group is azoospermia due to blockage anywhere in the semen-carrying ducts, and the second group is azoospermia causes where there is no blockage. In cases of azoospermia due to obstruction, sperm production in the testicle is usually normal or close to normal and a high rate of sperm is obtained. In the group without obstruction, sperm production in the testicle was impaired for any reason.
What procedure should be followed when the diagnosis of azoospermia is made?
When the diagnosis of azoospermia is first learned, it creates serious pressure, anxiety and uneasiness on couples, and most couples think, "Can't we have children?" The question is settled. First of all, the situation should be explained to the couple in detail by an experienced doctor, and information should be given about the ways to follow, treatments, and chances of success. Since the treatment process will be long in some cases, it is important to be patient with the patient-doctor relationship and the treatment process. After taking a detailed medical history, a series of investigations should be conducted to determine the cause of azoospermia. The main ones are genetic examination and hormonal examination. According to the results of these, the treatment schedule should be prepared and explained to the patient in detail.
How is azoospermia treated?
Except for congenital hormonal insufficiency, the main treatment of azoospermia is based on methods of obtaining sperm from the testicle. These are PESA and TESA, in which sperm cells are searched for by using a needle from the testicle, and MESA and microTESE, in which the testicle is opened and sperm cells are searched for.
How many times can TESE be performed?
In patients with sperm found in the procedure, TESE in repeated treatments. can be done again. Although there are no exact criteria for how many times this procedure should be performed, in the evaluation made by the urologist; Repeat TESEs can be decided based on criteria such as testicle sizes, hormonal values, quality and quantity of sperm cells found in previous procedures. Sperm was not found in previous TESE procedures. In n patients, first evaluation should be done for recurrent TESE, if there are treatable causes, they should be treated and then TESE should be planned.
Does TESE cause erection problems?
Decrease in erection and sexual desire. These are very rare effects after the procedure. Before the procedure, the patient's testicular size, hormone levels and comorbidities can be used to estimate these risks.
How long does the recovery process take after TESE?
TESE does not interrupt daily life too much. Depending on the extent of the procedure, patients can usually return to their daily lives after a 4-5 day rest period. However, this period is closely related to the severity of the work done by the patient and the person's pain threshold. Patients are usually discharged after being observed in the hospital for 4-6 hours after the procedure.
How long can TESE be repeated?
In cases where both testicles are treated, it is usually at least 6 days. No new transactions can be made until one month has passed. In some special cases, such as patients who underwent surgery on a single testicle or received cells only by injection, these rules may be relaxed by the doctor.
At what stage of the treatment should TESE be performed? Should the procedure be performed on women or men first?
The procedure for patients who will undergo TESE is in two ways; While for some patients, men and women are prepared together and the TESE procedure is planned on the day the woman's egg collection will be performed, for some patients, treatments for the man are planned first, the TESE procedure is performed, and if the sperm is found, it is frozen and treatments for the woman are started. It is necessary to decide which of these to do depending on the patient. The processes, the methods to be followed in cases of sperm coming out or not coming out, can be explained to the couple and their opinions can be obtained.
Should a piece be taken for pathology in every TESE procedure?
General practice is that especially if no sperm cells are found in the first TESE procedure, it is necessary for pathological diagnosis. is to take an example. In cases where sperm does not come out, this will give us an idea about the treatments that can be done and the ways to follow for the next treatments. In addition, it is important to take pathology for tumoral formations that may develop in the testicle, although there is a very small possibility.
TESE' Is it possible that sperm may not be seen in pathology even though there are sperm cells in the brain?
Yes, pathological diagnosis is only the result of the tissue piece taken. If sperm cells are not produced in every region of the testicle, which is usually the case in patients with no obstruction in the seminal duct, although sperm is present, there may be no sperm as a result of pathology. The opposite is also rare, but possible. In other words, although no sperm cells are found, sperm can be seen and reported in the piece sent to pathology. In this case, it would be appropriate to perform the TESE procedure on the patient again.
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