[PS-103]

Oturum adı: POSTER SESSION 2 | Oturum salonu: POSTER AREA | Oturum tarihi: 23 Ekim 2015 | Oturum saati: 14:00 - 19:00

Johnson Skoruna Göre Hipergonadotropik Nonobstriktif Azospermilerde m-Redo-TESE de Sperm Bulma Oranı Değişiyor mu?

Ahmet Salvarci1, Fatma Abasıyanık2
1Novafertil IVF Centers, Üroloji Bölümü, Konya, Turkey
2Özel Konya Patoloji Laboratuvarı, Konya, Türkiye

AMAÇ: Fsh toksik etkisinden kurtarılmış testis dokusunun önceki patolojik değerine göre HCG tedavisi sonrası sperm bulunma durumu değerlendirilecek.

YÖNTEM: Nisan 2013- Aralık 2014 arasında negatif m-TESE geçirmiş 100 hasta; Anemnez, fizik muayene, spermiogram, FSH, LH,total testosteron(tt), karyotip analizi, AzF delesyonlar bakıldı. HCG 3x1/haftada verildi.FSH normale (18±3.9 mIU/ml) gelen hastalardan 8-10 ay uzatılmış tedavi alan ve m-Redo-TESE (+) çıkan grupta patolojiler değerlendirldi.

BULGULAR: Yaş ortalaması 36±6 idi. 42 hasta tek-çift taraflı varikoslektomi, 3 hastada kabakulağa bağlı tek tarflı orşit, 11 hastada inmemiş testis öyküsü alındı.39 hasta 1 kere, 50 hasta 2 kere ve 2 hasta 3 kere m-TESE geçirmişti. 63 hasta kliniğimizin negatif m-TESE grubunda idi ve toplam 70 hastanın m-TESE patoloji sonuçları var idi.Genetik analizlerde patoloji izlenmedi.Testis hacimleri ultrasonda 6-18±7.1mm arasında ölçüldü. Ortalama FSH 29.5±4.1 mIU/ml, LH 15.4±2.1 mIU/ml total testosteron 322±126 ng/ml idi. Tedavi sonrası ortalama FSH 16.5±1.1 mIU/ml, LH 9.4±2 mIU/ml total testosteron 372±126 ng/ml idi. Altıncı ayda m-Redo-TESE negatif gelen grupta sperm çıkmamasına rağmen 50 hastanın 29 da önceki Johnson skoru 2,3,4 den 5,6,7 gibi değerlere yükseldiği izlendi. Tedavisi uzatılan 41 hastanın 9 de sperm bulundu. Sperm bulunan gruplarda önceki Jhs skorlamasında değerlerin 3 ve üzerinde olduğu izlenirken 3 ve altındaki gruplarda uzun dönem tedavininde etkili olmadığı izlendi.Johnson skoru 6 aylık başarısız tedavilerde düşük ve yüksek olmasının önemi görülmedi.

SONUÇ: Hipergonodotropik nonobstriktif azospermilerde önceden patolojinin bilinmesi HCG tedavisini başlamada bir kriter olabileceği düşünüldü.

Does the Sperm Detection Rate Differ at m-Redo-TESE in Hypergonadotropic Non-Obstructive Azoospermia According to the Johnsen Score?

Ahmet Salvarci1, Fatma Abasıyanık2
1Novafertil IVF Centers, Department of Urology, Konya, Turkey
2Private Konya Pathology Laboratory,Konya,Turkey

OBJECTIVE: The sperm detectability status will be evaluated following HCG treatment according to the previous pathological value in the testicular tissue liberated from the toxic effect of FSH.

METHODOLOGY: Between April-December 2014, anamnesis, physical examination and spermiogram was performed, FSH, LH, total testosterone (tt) was evaluated, karyotype analysis was conducted and AzF deletions were checked in 100 patients who had undergone negative-m-TESE. HCG was administered at 3x1/week. Pathologies were evaluated in patients with a normal FSH (18±3.9 mIU/ml), those who received a treatment extended for 8-10 months and in the group with a (+) m-Redo-TESE.

FINDINGS: The mean age was 36±6 years. Unilateral/bilateral varicocelectomy was performed on 42 patients; unilateral orchitis associated with mumps was detected in 3 patients and a history of undescended testicle was taken in 11 patients. M-TESE was performed once in 39 patients, twice in 50 patients and 3 times in 2 patients. Sixty-three patients were in negative m-TESE group of our clinic and m-TESE pathological results of a total of 70 patients were available. No pathologies were observed in the genetic analyses. The testicular volumes were measured between 6-18±7.1mm in the ultrasound. The mean FSH was 29.5±4.1 mIU/ml, LH was 15.4±2.1 mIU/ml and total testosterone was 322±126 ng/ml. Pursuant to the treatment, the mean FSH was 16.5±1.1 mIU/ml, LH was 9.4±2 mIU/ml and total testosterone was 372±126 ng/ml. Although no sperm was detected on the 6th month in the negative m-Redo-TESE group, it was observed that the Johnsen score of 29 patients out 50 patients, increased to 5, 6, 7 from 2, 3, 4. Sperm was detected in 9 out of 41 patients who received extended treatment. It was observed that the values were 3 and above in the previous Jhs score in the groups where sperm was detected while it was noted that long term treatment was not effective in the groups with a score of 3 and below. Low or high Johnsen scores were not regarded as significant in 6-month failed treatments.
CONCLUSION: It was considered that knowing previously the pathology in hypergonadotropic non-obstructive azoospermia could be a criterion for initiating the treatment.