Yardımcı Üreme Tekniklerinde Ürologun Rolü: IUI, IVF, ICSI ve Klinik Koordinasyon
Synopsis
Infertility is a global health problem affecting approximately 15% of couples, and a male factor contributes in nearly half of cases. Advances in assisted reproductive technologies (ART), particularly intracytoplasmic sperm injection (ICSI), have transformed the treatment of male factor infertility. Nevertheless, accurate identification of the underlying causes remains essential. This chapter reviews the role of the urologist in intrauterine insemination (IUI), in vitro fertilization (IVF) and ICSI in light of current literature. Urological evaluation before ART includes semen analysis, physical examination, hormonal profiling, genetic testing and assessment of sperm DNA fragmentation. Treating correctable etiologies such as varicocele and hypogonadotropic hypogonadism may improve semen parameters and enable natural conception. In obstructive azoospermia, minimally invasive techniques such as PESA and TESA are preferred, whereas Micro-TESE is the surgical approach of choice in non-obstructive azoospermia. Synchronizing Micro-TESE with oocyte retrieval, or cryopreserving testicular sperm, is decisive for treatment planning. Real-time communication with the andrology and embryology laboratory is also critical. In the future, in vitro spermatogenesis, stem cell-based approaches and artificial intelligence-assisted sperm selection may expand the urologist’s role. In conclusion, the urologist’s role in ART extends beyond surgical sperm retrieval and requires a multidisciplinary approach.
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