The ROSI technique, defined as the injection of spermatids into the oocyte by a unique technique, was described by Atsushi Tanaka, et al., in 2015. With the introduction of non-tail round spermatids in the treatment of azoospermia, we modified the management of the patients with microTESE accordingly.
Above all, the ability of the testicular stem cells to induce spermatogenesis should be investigated. There is no test to show that these cells work effectively. But the lack of certain genetic markers may indicate that there is a serious problem in sperm production that cannot be overcome by treatment. Unless any pathology could be shown to interfere with treatment, spermatogenesis can be stimulated with medications. There are two types of treatment protocols for stimulating spermatogenesis; i) hormonal manipulations, and ii) stem cell metabolism stimulants. The aim of hormonal manipulations is to induce germ cells with FSH to mature and to correct the imbalance between testicular testosterone and estradiol levels. Supporting products such as retinoic acid, resveratrol, folic acid, arginine, etc. have been proposed as regulators of germ cell metabolism.
However, before TESE, it is essential to demonstrate the presence of round spermatids in the testes that have completed meiosis. Our studies revealed that there are some important seminal markers that can be used for this purpose.
Here, in men who successfully passed these steps, we achieved near 20% clinical pregnancy by using TESE-derived spermatids. Cells taken after TESE should also be cryopreserved for further genetic investigations. According to the results of genetic studies, embryo biopsy (PGD) may be recommended. Finally, in case of pregnancy, pregnancy should be closely monitored. As reported, there are no significant differences between ROSI and naturally conceived babies in either physical or cognitive development during the first 2 years after birth.
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Prof.Dr. Kaan Aydos
Mahatma Gandhi Caddesi, 19/7 06700 Cankaya, Ankara / TURKEY
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