Varikosel Ameliyatı


Frequently Asked Questions in Male Infertility :


What are the other treatment options?
In couples who cannot have children by normal sexual intercourse after various drug treatments, microsurgery or endoscopic interventions but in whom satisfactory improvement is achieved, intrauterine injection is the preferred assisted reproductive technique to apply. This method (IUI), which has simpler, more economical and similar success rates compared with IVF-microinjection methods, more egg production in the menstruation period is maintained via drugs. In the maentime, the man gives sperm in the laboratory. The sperms are activated in suitable physical and chemical environments and those which might have potential for insemination are selected, and are sent to a gynecologist under suitable conditions and injected into uterus with a special cannula. In this method, there is a chance of up to 20% pregnancy in every trial (pregnancy probability is 30-35% for each menstruation period in completely normal people). It has recently been stated that with new application materials (PAF-IUI), considerable increases in these rates are achieved. This simple and economical method should be tried at least four times within menstruation periods accompanied by the right application of the spouse monitoring and preparation of sperm.

For men who cannot get effective results from this method or who do not have satisfactory spermiogram values for this method, the last resort is ICSI (Intra Cytoplasmic Sperm Injection) application, an IVF method. In this IVF method, insemination is maintained by placing a single healthy sperm inside a single egg and the inseminated egg is placed in the woman’s uterus. During this period, the high dose of hormones given to the woman for producing a lot of eggs might give rise to undesired effects like serious health problems and early menopause. While the children are generally born healthy, it is known that there has been a slight increase in birth anomalies and miscarriages. This expensive and complicated method, which is also called microinjection, has provided a chance for males who are previously considered incapable of  having any children but have few sperm in their semen or testicles; the rate of having children in every trial is around 25-30% (Take home baby rate).
Recently, there have been promising studies on men who have no sperm cell. Examples include copying and producing insemination cell (root cell) from other body cells. These methods which are now in the stage of animal experimentation are expected to be used widely in the near future.

What should couples who cannot have children do initially? Should the man or the woman apply to the doctor first? Couples who cannot have children should be examined simultaneously. Women should be examined by a Gynecology specialist and men should be examined by a Urology-Andrology specialist. The interaction between these two specialists is important. It is not appropriate to go to a private IVF center initially. It is not right to apply IVF applications directly while there is still a chance to have baby with other types of treatment, which are both easier and more economical.

Could you tell us about the causes and types of male infertility?
Male infertility may arise from various reasons: hormonal factors, genetic-familial factors, history of inflammatory diseases or surgeries, birth anomalies, environmental and chemical factors, etc. The most coomon and also treatable microsurgery is varicocele, which can simply be defined as the forming of varicosis in testicular veins.                              
Could male infertility be secondary to drugs?
Use of substances like heroine, morphine and substances that body-builders use for doping effect might prevent having baby or have hindering effects. These drugs harm the normal hormonal balance of the body while trying to strengthen muscles and as a result of excessive use, the reproductive cells and systems may be deactivated and weakened.
Could smoking be the cause of infertility?
Smoking creates a negative effect on the sperm structure. In extensive studies it has been observed that these kinds of problems are more common in smoking men.
Is alcohol use a cause of infertility?
No. Social drinking has no effect on sperms. When used in excessive amounts and for long periods, alcohol causes problems. However, smoking is more detrimental than alcohol.
How does duct obstruction, one of the causes of male infertility, occur?
This is due to four different causes.

  1. Obstruction may arise due to cysts developing over time.
  2. It could arise by doctor’s practice of tubal ligation as a result of a birth control method called vasectomy.  
  3. It could be congenital. It may arise due to genetic factors by partial or complete underdevelopment of tubes which are transport ways.
  4. As a result of sexually transmitted disorders some obstructions may arise in these canals or as a result of inability to treat disorders transmitted from women with gonorrhea.

Now it is possible to maintain pregnancy via normal ways by removing obstructions causing infertility with special microsurgical and endoscopic methods.

Does mumps cause infertility?
30% of adult males with mumps have distension in the testis and the virus affects the testis. If it is bilateral and the eggs producing insemination eggs are harmed completely, infertility arises. A male with no history of childhood mumps should be vaccinated and if they catch the disease, they should use drugs which prevent testis infection.

Which of the causes of infertility could be cured?
The most common and curable cause of male infertility is varicocele. Varicosis formation in testicular veins which starts in adolescence, advances in time and decreases the number, activity, and insemination power of sperms. It could be removed with special microsurgical techniques. The technical success of microsurgical method by specialists is over 99% and 80%. Those who had unsuccessful varicocele surgery formerly can also undergo microsurgical technique. With this new method, which I have applied on approximately 2500 patients over the past 15 years, a lot of people have had babies via natural ways. Moreover, with this technique, the insemination rates of the patients who need injection and IVF methods are increasing, too. If obstruction is detected in semen tubes, microsurgery and endoscopic operations for removal can also be performed. In cases where satisfactory results cannot be obtained, assisted reproductive techniques are applied incrementally. Initially sperm production of the man is raised to maximum and then insemination is maintained via injection or test tube baby method. Those who have hormone deficiency could be treated by means of drugs.
What kind of a method is injection?
After the male gives semen, the best of these are chosen and activation is increased by some chemical substances. In the same way, after increasing the egg number and quality of the woman with drugs, injection operation could be performed in a specialist’s clinic. Without the need for anesthesia, the man’s sperm is sent to the uterus of the woman with an injection and the sperms are expected to fertilize the egg. This method is used in both male and female infertility. The treatment of those with varicocele before the treatment increases the success rate.
What are the infertility problems related to sperm?
Lack of quantity, consistency, low cell activity, dead cells and inflammation might be among the possible causes. Structural disinformation can also be observed in the sperm cells. These cannot be noticed by the eye but evaluated by specializing andrology laboratories with staining methods and microscopic analysis.
Considering the conditions available today, who cannot have children in any circumstances?
Men with no sperm cell in their egg cannot have children. However, with the improving technology and root cell studies it is assumed that this problem will be solved, too. There have been studies to enable people with no sperm cell even in their eggs to have children by changing the root cell from the body with sperm cell. As for cloning, that is, copying method, only one of the spouse’s genetic materials is used and the child to be born is not a mutual product but the genetic copy of one of them.
Are there any infertility treatments that cannot be applied in Turkey?
No. Every operation can be conducted successfully in Turkey. Due to high number of cases, success rates are over those of very advanced centers. To exemplify, if I had continued my studies abroad, I couldn’t have reached the number of over 3000 microsurgical varicocele operations. Thus, I recommend that patients consult real experts and avoid commercial practices carried out with financial concerns. I also recommend consulting the urology clinics of medical schools.
Where should a man apply?
He should apply to a urology specialist who is concerned with andrology. Andrology is a two-branched science; infertility is related to barrenness, impotence is about manhood problems. Couples should first consult doctors specialed in these areas before applying to test tube baby centers. In this way, many simple problems can be treated and people can have children in natural ways. A method as expensive and complicated as IVF should be applied as a last resort. For example, in a man who has cancer initiation in his testes, the number of sperms decreases and if this man starts test tube baby practice without being examined by a urologist, he might endanger his life. Similarly, a minor problem that can easily be solved with a simple initiative might be ignored.
How should we start the treatment?
Actually, couples should start at the same time. However, it is of benefit to start with the examination of the male. Due to our cultural structure, when the problem of infertility arises, first women are sent to doctors; men visit the doctor in the later phases or prefer not to visit any doctors. What happens is initially women infertility is investigated in detail and many treatments are applied unnecessarily. A man who cannot have children should first consult a urology specialist focusing on Andrology. Principally examination, special sperm and hormone analyses are conducted.
Treatment in male infertility is applied in stages; initially simple and cause focused treatments are preferred. By removing the problem completely, drug treatment, microsurgery, endoscopy can be applied in order to enable pregnancy in the couple’s home. Even if it is not a definite treatment, the man’s condition can be partially improved with this treatment and he can be enabled to benefit from the assisted reproductive techniques with higher success rate. Appropriate couples may benefit from the injection-insemination method, in which the sperms of the man are given to the woman after being prepared in the laboratory by the gynecologist while for those with heavier conditions, microinjection- IVF can be applied as a last resort. In microsurgery, benefit rate is 80% in appropriate people and pregnancy may reach the level of 40%. In injection, 20% pregnancy, and in test tube baby method 25% pregnancy may be achieved per trial.

Today, full infertility is even less rare. With microsurgery, endoscopy, and assisted reproductive techniques, now couples may have children even in cases with history of unsucessful attempts. Men should have detailed examination instead of blaming their wives. A single sperm analysis which seems normal is not adequate. Moreover, a man with children may become infertile in time for example by the effects of varicocele. In our country, all advanced examination and treatments can be applied in infertility treatment. However the principles of quality control and incremental treatment might be violated; often many examination and treatments are not performed in the required quality. Also due to commercial purposes, without trying necessary examination and simple treatments, couples may start expensive and complicated IVF methods, which could lead to complications in mother and baby health. Without first trying very simple and economical solutions and especially improving the men’s state with treatment, one should not try IVF methods. Microsurgery, endoscopy, and drug treatment enable many couples to have children without the need for IVF, at least increase their success rate in IVF proceedures.



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