Now let us tell you about our method and logic of examining the development cells in the intermediate steps until the mature sperm, which is the main follow-up criterion in azoospermic (no sperm) or oligospermic (few or insufficient sperm) patients.
We know very well that
There are a number of cell development stages until a mature sperm cell, i.e. spermatozoa (also called spermatozoid) develops.
How do we know this?
The experience obtained from testicular biopsies is proof of this. What is less known here is that it is thought that it is only possible to see this in the tissue.
However, thanks to large and detailed microscopes and specially developed nuclear dyes, leucocytes and precursor germ cells can be counted separately from each other and we can have an idea about the testicular production capacity of the owner of the semen.
In the semen examination of a good testis, it is now possible to see all intermediate step cells except the stem cell (spermatogonium: only in the tissue because it is adjacent to the basement membrane in the tissue) in the floating or precipitated semen fluid.
After the spermatogonium, respectively: stage zero = 0
Primary spermatocyte (duplicate stem cell; 46 xy or 46 xx) = stage 1
Secondary spermatocyte (23x-23y or 23x-23x halved material develops by meiotic process) = stage2
First round spermatids (the tail is not visible in these, the nucleus is larger and has a more circular structure. According to their micron diameters, the first 12-15 micron diameter, then the more mature 10-12 micron diameter develops) = stage 3, stage 4
The diameter of the spermatid in the FSH-activated cycle is around 8-10 microns and the tiny tail starts to emerge from the centriole = stage 5
Elonge stage = stages 6 to 7.
Here, with a method we have developed, we categorise the elonge cells into 7 different phases, essentially following the steps during the filtration of the nucleus from the nucleus in the form of a photo frame for you and targeting the semen sample that finds the best response in maturation.
We do not see this change in healthy sperm donors, i.e. non-azoospermic patients.
In azoospermic patients, however, somehow the transformation of the nucleus and stagnation into a mature spermatozoa cell is delayed in these stages, which we call maturation.
Some researchers attribute this to low-energy mitochondrial activity in the arrival of DNA and RNA, while others recognise that there are multiple causes and attribute it to the imbalance in the microenvironmental integrity, especially after multiple TESE.
If we want to give an example here; in a healthy person, we need to see all the above phases together with the first 5 phases and then mature sperm cells.
If we give another example, FSH is extremely high, testosterone is extremely low, testicular volume is extremely small, a patient is taken to micro TESE and although the pathology is Sertoli Cell Only, that is, there is no stem cell at all, we found a few sperm (!)
Now, the lies of those who say that we are placing him with IVF will be clearly revealed.
In such a case, it is not even possible to see any intermediate step cell sample in the semen detail analysis, let alone carrying the case to unnecessary micro TESE, let alone carrying the case to unnecessary micro TESE, both the patient’s tissue that can be developed and the economy are damaged due to financial ambitions by saying that we have found sperm.
I regret to state that I am faced with hundreds of the examples I have given above.
Prof. Dr. Paul Tureck, who is considered the doyen of this analysis system in the USA (google azoospermia and you will find the tureck clinic in the 3rd or 4th place. In the 3rd or 4th row, you will come across the tureck clinic; look at the sperm mapping section), we know from his website and interviews with him that he decided to do TESE by entering the testis with the micro-needle method (tefna = testicular fine needle aspiration) and taking multiple samples (tefna = testicular fine needle aspiration) by entering about 20-30 places and numbering the regions that he enumerated, not preferring the regions with poor histology, just like we do, but preferring the histology-rich tissue, and that he demanded a figure of around $ 7000 for this procedure.
While Prof Tureck has expressed his opinion by publishing a study of 169 cases that he considers micro TESE as a very damaging invasive procedure and that micro TESE should only be recommended for a case with a low chance percentage and a low chance except for 2-3 regions, our country is carried out in a very ordinary way with the logic of TESE for those who come with a random logic without looking at the necessary unnecessary detailed detailed detailed calculated calculated unaccounted treatment untreated treatment unpredictable predictive unpredictable.
This is why we have named this type of TESE as diving TESE.
Despite all these scientific publications and developments, it is necessary to see that the era of this irregular logic is over with a correct bookmark on the way to a process in which azoospermia patients are unnecessarily distracted with random unscientific hormone treatments with a system that does not have a proper and follow-up follow-up criterion, which is our whole purpose.
The recent spread of this awareness and the marked superiority in the chances of cases without TESE is the biggest evidence for this.
In that case, any surgical procedure without a good foresight, i.e. TESE or micro TESE, will not only not be beneficial, but will also cause the root of a tree that does not bear fruit due to malnutrition to rot completely by continuously cutting the root.
Summary Rule:
The success rate in cases will be higher after a good patient history, a good prediction, a good follow-up criterion and a good treatment follow-up.
