In about 50% of the couples trying to conceive, a male factor is responsible. Gonadotropins in hypogonadotropic hypogonadism as well as anti-inflammatory drugs and antibiotics in selected cases are medical agents with proven effectiveness. However, 30-40% of men presenting with infertility are ultimately labelled as having idiopathic infertility, with no identifiable cause. Although these men present with no previous history of diseases affecting fertility and have normal findings on physical examination and routine endocrine, genetic and biochemical laboratory testing, capacity of the conventional seminal analysis and hormonal findings to predict reproductive potential is limited. However currently introduced other additional screening tools, such as oxidative stress and sperm DNA damage, as well as epigenomic and proteomic biomarkers, metabolomic profiling may reveal some specific pathological findings and help to predict fertility potential in a more accurate manner. For this reason treatment of an infertile man should be planned by using an analytic perspective regarding such developments. This allows a customized therapeutic strategy. Different protective and treatment regimens may be offered to eliminate detrimental outcomes of reactive oxygen species, epigenetic modifications, endocrine disruption as a result of environmental pollution, etc. Also, next-generation sequencing (NGS) test has contributed to the identification of novel genes responsible for fertility potential and gives the opportunity to make key decisions in the management of infertile patients.
Azoospermia due to failure in spermatogenesis is defined as non-obstructive azoospermia (NOA). In infertile patients with NOA, sperm can be retrieved successfully by mikroTESE procedure with help of the magnification provided by an operating microscope. Sperm retrieval rates are between 30%-50% in NOA cases, but it depends on the underlying pathology.

Although mikroTESE is the gold standard technique to find spermatozoa it should be considered as only a part of the whole process targeted to obtain a healthy pregnancy. However, in patients with NOA in which sperm production is impaired in the testes, microTESE should not remain as a surgical intervention. The ultimate goal to perform mikroTESE is that the couple has a healthy baby. Therefore, the ideal one should first be to maximize the likelihood of sperm retrieval. And also, in case of no sperm in the intervention, a forward-looking treatment plan should be determined. We call it as the “Multi-dimensional microTESE” model. Multi-dimensional microTESE model consists of four successive steps:

1. Predetermination of the sperm production level in the testicles
2. Optimization therapy to maximize the likelihood of sperm retrieval in the following microTESE
3. Detailed microTESE coupled with tissue sampling for biomarker investigation.
4. Planning future treatment according to the marker results.
Varicocele occurs in 15–20% of all men and in 40% of infertile men. It causes male factor infertility by several pathophysiological mechanisms; mainly testicular hypoxia due to venous stasis, impaired hormonal functions, reflux of renal and adrenal toxic metabolites, and increased testicular temperature. However, increased oxidative stress resulted from over-production of reactive oxygen species (ROS) and the reduced total antioxidant capacity may also decrease fertility chance in men with varicocele by causing increased sperm DNA fragmentation and sperm apoptosis. Varicocele repair in men with clinically palpable varicocele and no female related factor may improve pregnancy outcome in at least one third of the cases. In non-obstructive azoospermia cases approximately 10% of the operated men will have enough sperm in the ejaculate to avoid testicular sperm retrieval. 13%-18% of them with sperm in their ejaculate achieve pregnancy. However, men with late maturation arrest and hypospermatogenesis on testis biopsy have a higher probability of success up to 40%. Microsurgical varicocelectomy is the gold-standard technique treating varicocele, due to relatively more favorable outcomes and lower post-operative recurrence and complication rates.
Obstructive azoospermia is resulted from obstruction of the seminal ducts at epididime, vas deference or ejaculatory duct levels. Microsurgical vasoepididymostomy and vasovasostomy are the treatment choices for epididymal and vasal obstructive azoospermia patients, respectively. According to our results the overall patency rate after microsurgical vasoepididymostomy is 50 % and the median time to patency after surgery is 3 months. However, patency success is related with localization of the obstruction and presence of motile sperm in epididymis fluid. Success rate of vasectomy reversal by microsurgical vasovasostomy is much higher than former.


You can send your questions to
Prof.Dr. Kaan Aydos

Mahatma Gandhi Caddesi, 19/7 06700 Cankaya, Ankara / TURKEY
+90 312 437 3121   +90 312 508 2258