Yardımcı Üreme Tekniklerinde Ürologun Rolü: IUI, IVF, ICSI ve Klinik Koordinasyon
Özet
İnfertilite, çiftlerin yaklaşık %15'ini etkileyen küresel bir sağlık sorunudur ve olguların neredeyse yarısında erkek faktörü rol oynamaktadır. Yardımcı üreme tekniklerindeki (YÜT), özellikle intrasitoplazmik sperm enjeksiyonundaki (ICSI) gelişmeler erkek faktörlü infertilitenin tedavisinde bir dönüm noktası olmuştur. Ancak altta yatan nedenlerin doğru tanımlanması önemini korumaktadır. Bu bölümde intrauterin inseminasyon (IUI), in vitro fertilizasyon (IVF) ve ICSI süreçlerinde üroloğun rolü güncel literatür ışığında ele alınmıştır. YÜT öncesi ürolojik değerlendirme semen analizi, fizik muayene, hormonal profil, genetik testler ve sperm DNA fragmantasyonunun incelenmesini kapsar. Varikosel ve hipogonadotropik hipogonadizm gibi düzeltilebilir etiyolojilerin tedavisi semen parametrelerini iyileştirebilir ve doğal gebelik şansı sağlayabilir. Obstrüktif azoospermide PESA ve TESA gibi minimal invaziv yöntemler, non-obstrüktif azoospermide ise Micro-TESE tercih edilen cerrahi yaklaşımdır. Micro-TESE’nin oosit toplama işlemiyle senkronizasyonu ya da testiküler spermin kriyoprezervasyonu tedavi planlamasında belirleyicidir. Androloji ve embriyoloji laboratuvarıyla eş zamanlı iletişim de bu süreçte kritik önem taşır. Gelecekte in vitro spermatogenez, kök hücre temelli yaklaşımlar ve yapay zekâ destekli sperm seçimi üroloğun rolünü genişletebilir. Sonuç olarak üroloğun YÜT’teki rolü cerrahi sperm elde etmenin ötesine geçmekte ve multidisipliner bir yaklaşım gerektirmektedir.
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