TO PROFESSOR DOCTOR ATSUSHI TANAKA AND HIS TEAM
First, we would like to thank you for accepting/inviting us and letting us be a part of your study.
Our practice in Turkey has a very similar approach when it comes to treating azospermia cases.
It was about around the same time as yours when we started getting successful results with efficient gonadotropin treatments for azospermic males in terms of being able to provide natural sperm ejaculation.
With the inspiration of 100% success on hypophyser cases we observed that following the same principles on non obstructive testicular cases gives us some positive improvement . We proved that those who claim the healing is not possible on regressed systems and who claim the hormonal treatment would not work are wrong . These cases though were more complex cases compare to other groups . The worst was almost all of them had microtese procedure done without any criteria. Because of this our first statement was about stressing the importance of having some criteria before micro-tese procedures . We said “no” to micro-tese if it is done routinely , randomly, and rushed without any pretreatment .
We decided to observe in detail the sperm germ cells with classic semen specimen and improved/modified the dyed spermiogram methode . The follow up methode was recording the data at the beginning and every 3 months period after starting the treatment to check the development of mytotic activity and maturative activity indexes and come up with a mathematical calibration .
Also for patients who haven’t gone under tese surgeries we developed a risk analysis system . After the elimination of the obstruction now our system with the detailed sperm germ cell analysis including the possible success rate proved its reliability.
Like in the idea of Prof.Dr Paul Turek’s FNA (fine needle aspiration) technique on processing sperm mapping procedure , basically determining the localization of quality germs in order to achieve a higher success rate rather than doing it randomly we stressed that without pretreatment , without calculating the possible outcome , randomly and routinely done microtese procedures are not the best way to approach in treating azospermia patients. We know that this concept is also accepted by Foresta and his colleagues in Italy and they had similar studies . With the assist of today’s micro-fish test ,evaluating the data of haploidize DNA’s maturation process in candidate spermatids’ nucleus for ROSI or ELSI is going to be our next step. Our final goal is to perform PGD NGS test and proceed with the right embryo for the transfer .
Soon we will be checking the genetic expressions of azospermia patients and with that information we are planning on using gene technology for treatment purposes.
The article published by Shiraishi and his colleagues in Yamaguchi 2017 is emphasizing the importance of gonadotropin treatment and preparation of making all the conditions ideal before the micro-tese procedures. Since 2012 in addition to many successful cases we have had , also we were able to see the development of these cells starting from Sertoli cells only to target or candidate spermatids . We have seen patients got pregnant naturally and spontaneously and had healthy babies , we have seen patients got pregnant provided with spermatids and had healthy babies . Surely most of our successful cases were accomplished by providing natural ejaculation. The rest was with in vitro sertilization .
However , in most Sertoli only cell stage cases we still were not able see any further than maturation arrest. Our success rate of accessing initial stage of spermatids( 6-8 micron diameter) was as high as 80% . So I like to emphasize the importance of using gonadotropin in the right time . We value your experience and would like to learn more about and share. We believe It is crucial to learn from international platforms . The more shared information the more benefit the humankind will get .
Detailed sperm germ cell analysis progression indexes revealed that elongated spermatids were formed before the 6-8 micron diameter spermatids . This observation made us think the reason elongated spermatids developed like this was due to morphological stimulations in inhospitable environment . On individuals with healthy sperms we noticed the elongated sperms are very rare however when there’s is a small decrease the first sign was the presence of 6-8 micron diameter spermatids . Obtaining these spermatids from the semen without tese procedure we have had patients got pregnant and embryos with normal genetic.
Since we have been doing this for 6-7 years we consider ourselves we are still at the beginning , we don’t have enough room to make mistakes and we want our patients to get best treatment possible with less damage physically and economically so we decided to learn from your knowledge and experience . We have seen so many cases it says “Sertoli cells only ” on their tese pathology report but even without any treatment after reviewing the initial semen analysis we noticed some sperms can be actually used and some spermatids with acrosomal cap .
Acibadem hospital groups have been providing quality care for over 20 years in Turkey . On behalf of our medical schools , hospital complexes , and all other clinics and institutions that have been accepting large quantity of patients coming from all over the world for treating azospermia , with established Turkish-Japan friendship , in the near future we would like to organize a symposium in Turkey in terms of catching up new data information , and sharing the experience to serve better to humankind .
In order to promote detailed sperm germ cell analysis system and endocrinological proper gonadotropin treatment as a key principle we will be gladly open to share information . I would like to express our thanks on behalf of my colleagues .
Kind regards,
