Prof.Dr. Kaan Aydos | 05 November

The new ROSI procedure which is defined as round spermatid injection into the oocyte evoked a new hope of becoming father in azoospermic men with no mature sperm cells in their testicles, and then in the last 5 years, many couples were treated with this method. In line with our own results, the success of this method is about 15%. Considering that only 40-50% pregnancy can be achieved in in vitro fertilization with mature tailed sperm, this success is not a rate to be underestimated. However, unfortunately, most of the cases admitted to ROSI cannot achieve pregnancy. When we evaluate the cases within the period approaching 1 year from the day we first started ROSI, some details that will increase the success also have begun to emerge. Our experiences indicate that a careful assessment of the man before ROSI can increase the pregnancy success.

First of all, it is necessary to determine which men are eligible for ROSI. Some markers that we have been working on for a long time have an important role in making this decision. Our studies also showed that stimulation of germ cells with appropriate medications for 3-6 months contributes to a certain maturity level in the genetic structure of the immature cells, thus increasing fertilization success. In fact, we have observed that the addition of FSH hormone to the testicular cell culture medium can significantly improve the genetic expression of sperm cells. However, for this improvement to occur, certain receptors of the supporting cells in the testis must be healthy. Here, if azoospermic men having the cells with these properties are selected and treated according to certain protocols, the success of ROSI can be expected to increase. This means that unnecessary inconvenience and expense will be avoided by eliminating the unpromising cases, but a high rate of pregnancy will be obtained in the appropriate cases.

We also found that some azoospermic men have insufficient enzymes that allow sperm cells to be released from the supporting cells in the testicle. In such cases, enzymatic digestion is required for the preparation of tissues taken with TESE. Indeed, the success of sperm retrieval in TESE tissues processed with enzymes increases significantly compared to non-enzymatic method.

In conclusion, in cases where ROSI has not been successful, everything is not finished yet. After passing through the preparation steps mentioned above, retrying ROSI may reverse the negative result. Our studies on this subject are still continuing extensively.


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