Prof.Dr. Kaan AYDOS
İnfertilite nedeniyle tetkik edilen çiftlerde ÜYT’in kullanılmasına karar verilmesinde erkek faktörünü düzeltebilecek ve fizyolojik yollardan gebeliği sağlayabileceği şartları kazandıracak her türlü diğer tedavi alternatifleri gözden geçirilmelidir.
Daha önce azoospermi nedeniyle takip edilirken TESE – ICSI uygulanmasına karar verilmiş bazı erkekler transrektal ultrasonografi (TRUS) ile değerlendirildiğinde ejakulatör kanallara bası yapan ve azoospermiye neden olan bir orta hat kistine rastlanılabilir. Kistin USG eşliğinde transrektal yolla boşaltılması sperm parametrelerini normale döndürerek spontan gebelik şansı elde edilebilir. Daha önce belirtildiği gibi Yamamoto, IVF-ET yapılan ve başarısız olunan 13 olguda daha sonra varikosel operasyonu yapılmasını takiben IVF-ET tekrar denendiğinde %31’inde gebelik elde edildiğini bildirmiştir (2). Azoospermi ya da ileri derecede OAT bulunan erkeklerde eğer obstrüktif bir etyoloji teşhis edilebilirse, bunlara mikrocerrahi yöntemle vazoepididimostomi yapılmasını takiben %43’e varan oranlarda spontan gebelik sağlanabilmektedir (5). Torok, plasebo kontrollü 27 infertil erkeğin tedavi edildiği bir çalışmasında, 3 ay süreyle günde 20 mg Tamoxifen kullanmış ve seminal parametrelerinde anlamlı düzelme, %33 oranındada gebelik bildirmiştir (6). Plasebo kontrollü ve randomize beş çalışmanın meta-analiz sonuçlarını bildiren bir başka çalışmada ise, oral kallikrein kullanımının gebelik oranlarını anlamlı derecede artırdığı gösterilmiştir (7). Astenozoospermik infertil 51 erkekte de serbest oksijen radikallerinin araştırılmasını takiben, oral vitamin-E kullanımının spermatozoada malondialdehyde düzeyini anlamlı derecede düşürerek zararlı antioksidan etkiyi azalttığı ve neticede plasebo alan olgularda %0 olmasına karşın, tedavi gören hastalarda %21 oranında spontan gebelik elde edildiği gözlenmiştir (8).
Bütün bu sonuçlar, erkek faktörünün detaylı bir değerlendirime tabi tutulduğunda ya da belirli bir süre tedaviye alındıklarında, bazı infertilite 
olgularında ÜYT’e gerek kalmadan spontan gebeliğin elde edilebileceğini, bu şekilde gereksiz yere kadının hormonal veya girişimsel manipülasyonlarına gerek kalmayacağını , ayrıca ekonomik yönden de koruyucu olunabileceğini açıkça ortaya koymaktadır. O halde, infertil çiftlerde ÜYT kararı verilirken tam bir androlojik değerlendirim’e gereksinim vardır. Ancak bütün tetkikler yapılıp başka tedavi seçeneği kalmadığı anlaşıldıktan ve belgelendikten sonra tedaviye geçilmesi uygun olur.
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