Let’s say you had a spermiogram several times and each time you were told that you have azoospermia. For some reason, even though it is known that there will be no result, patients are forced to undergo micro TESE by saying that we can only find sperm with TESE and the result is disappointing.
Let’s say pathological diagnosis is very important. However, it is a fact that they themselves accept; each repeated micro TESE further reduces the chance of success. Do you know why?
You already have a regressed system; they cannot get results while detecting the system at its weakest moment with instant TESE. The rates given in publications are always exaggerated. That is another dimension of the work. Look, we conducted a survey in the azoospermia group. The result is 2 per cent.
With TESE, the structure called seminiferous tubule in the testicle is cut. But this operation damages the tissue. You can cross to the other side with a bridge. You’re destroying the bridge. The ropes and legs of the bridges are cut. You want fruit from a tree. You look at it with your eyes; the tree is dry. But no one asks why it is dry. There is a disease in its root, soil, branches and leaves; it needs treatment.
The decision is this:
I will take a bud from the root and maybe I will find it. So we say; let’s do maintenance first. Let’s review the air, water, soil, minerals, sun, branch, leaf. Where there is a need, where there is a problem, let’s do maintenance accordingly.
The point I am going to make now is this. We clearly see that this regressing system can be repaired with treatment. We also have a system that predicts the sperm precursor cell detail, which is used to measure the testicular reserve without the need for surgery. I have already written about our hormone monitoring reference system. We can follow it with double control. Everyone’s chances are not guaranteed, but their chances are much higher. Especially those who have never had an operation have a much better chance.
Otherwise, the certainty that they won’t get a result is more certain. I have a doctor friend. Dr Murat Bey. How meaningful is the word he told me. I have been a coordinator in a 25-year IVF centre. I have only seen sperm output with micro TESE a total of 3 times, so let me give a rate, he said 1 percent chance. He added that thanks to you, I learnt that an azoospermia patient was treated. It was one of his patients, it turned out that we had treated a teacher friend named İsmail K. They did a micro TESE, Murat Bey’s teams. When I coincidentally sent my patient to him, I remember you, you were someone we couldn’t find sperm with micro TESE before, and when I asked him how it happened that sperm came out spontaneously, he said, “I go to a doctor named Celalettin Bey and that’s how it happened.” Murat must have listened to me so much when I told him what I was busy with at the iftar dinner a year ago that he called me with congratulations, saying, “Wow, my classmate, it turns out how true what you said was. Now, doctor friends have started to refer patients to me.
In other words, a charcoal order has taken over in our country, and this is the curve and this is the truth. This wrong must end now. Look, I am not hiding information. I am expressing how we treat by explaining how we treat with the rules. We are ready to make every effort to provide training and support in this regard. Let’s take a look abroad. They have also turned to this now. Publications no longer hide this. Hormone therapy is the main method of renewal in testicular tissue, providing environmental organisation and treatment must be individual. In other words, each patient is special for himself. And it is a fact that multiple micro TESE increasingly jeopardises the chances for the patient.
Sometimes they do one TESE and damage 10 TESEs. I am referring to the philosophers who say that once I do TESE, I do it once, I open everywhere. This approach challenges me the most. You provide sperm output, but the micro-order, micro-circulation is disrupted; here is a morphological disorder. It is challenging. Unfortunately, this type of TESE makes it compulsory to search with TESE continuously. Therefore, if you cannot benefit, at least do no harm is the most correct philosophy. Some of them do this. But they will also read and learn, don’t worry. One of them sends a patient and tries to find out what medication I have given, then he did the treatment according to his own mind and operated, but the result is frustrating again. Do you know why?
He doesn’t have the sperm precursor cell details, come on, it’s random. That’s not right either, but it’s too late. He’s damaged the testicle a second time. One of them expressed his astonishment and said, “Believe me, I was very hopeless before the operation, but I am very curious about such easy sperm output, come back sometime and let me talk to you about what you have taken,” and he is looking for the solution at the wrong address through the patient. Have you ever thought why do you think he is looking for it? They explain our method, but there is pride, that pride. It is because of this pride that when that senior person is invited to a seminar about this place, he directly refuses… Our pioneering young brothers who are looking for a cure for azoospermia see an unexpected behaviour and leave that address in sorrow.
One of the most important problems in the azoospermia group in our age is the last stage, which we call maturation arrest (pause, silence), which is a picture of sperm stuck in the elonge cell stage and unable to progress to mature sperm. The problem is less in those without TESE. However, in those with TESE, while we can advance the system completely from zero to this step (0-6), we are insufficient in the transition to the last step. World scientists have come to a conclusion on this subject. They have shown that in cases that cannot reach the tail stage, first elonge (stage 6) and then round spermatids (stage 4-5) can also provide pregnancies in more backward stages (stage 4-5). Efforts in this field are very insufficient in our country. (Google: tanaka fourteen babies born)
At this time, a university study supported by Tübitak was initiated in our country. Previously, it has been shown that Sertoli cell only level samples from tese tissue can be matured to more advanced stages under laboratory conditions. Developments seem promising. From here, all our azoospermia group friends will be shared as information is received.
