The term deletion, which means deficiency, is used in medicine for the lack of some genetic command areas locally on the Y chromosome, which we accept as congenital.
If there is a deletion in region A, it is not given a chance because there is no stem cell command. However, in our country, unfortunately, conscious and unconscious micro TESE continues to be performed on patients who were previously diagnosed as having A deletion but were never given the chance.
Anyway, let’s get back to our case;
H.U. Our patient named applied with azoospermia and stem cell deprivation. I think there was also a micro TESE applied. At that time, I was using herbal materials that lowered FSH and LH and were effective on the germinative epithelium. In detailed microscopic sperm germ precursor cell analysis, although the system was far behind (6 spermatids), an increase in germ activity was detected with phytotherapy products, and a few spermatozoids began to be seen. Our patient’s 5 cm. and 7 cm. Although the testicular volume is approximately 8 mm in the left testicle of one of them. Since a large hypoechoic area was observed on ultrasound, we monitored it only with phytotherapy without using HCG as a precaution to avoid risk of tumor.
After a while, following spermatid proliferation, we added menotropin (FSH and LH) as soon as the number of sperm began to increase. The number increased sufficiently, but urological consultation was performed because the volume of the mass increased in parallel with the increase in testicular volume.
Some opinions were that the testicle should be removed directly and treatment for chemotherapy should be given immediately. However, by taking the middle path with consultations, sperms from the current operation material were frozen externally and internally. Since the result of the surgery was not benign in the play and upon the request of his family, after the treatment was completed successfully, microinjection was performed and twin boys were born in good health.
We did not knowingly use HCG in the treatment, but we make close radiological observations because we know that this risk is relatively increased in undescended testicles and genetic cases.
Not every AZFc deletion case may be able to produce sperm as fortunately as this case. The last stage, the maturation stage, is the most common problem we encounter. Sperm anomalies are common in these cases.
We had two more such friends in the ROSI trials. M.E. and U.P. In the initial stages, typical germ cell aplasia, that is, stem cell failure, that is, Sertoli only cell, that is, the stage where not a single stem cell other than the Sertoli cell is observed; They reached the final stage with the treatment we carried out with correct endocrinological and phytotherapeutic principles. Later stage ROSI candidate spermatids were reached. Very successful embryos were created. Unfortunately, transfers were not made because no healthy embryos were detected in the PGD NGS test performed at the center where we worked at that time. We will continue to work with treatments and trials until we reach the right embryo.
I wanted to let you know what stage we are in with this article, which I wrote to set an example for friends who are in this direction. We are now in the age of genetics. So, we will implement whatever the possibilities of that age require.
