Erkek infertilitesi tedavisinde güncel cerrahi yaklaşımlar

Infertility is defined as the inability of a couple to achieve spontaneous pregnancy despite regular unprotected intercourse for one year. Approximately 15% of couples fail to conceive within this period and require infertility treatment. To categorize the underlying cause of infertility, both partners should be evaluated simultaneously. In about 50% of infertile couples, a male-related factor is identified, often associated with abnormal semen parameters. Furthermore, if the female partner is older than 35 years, an early infertility evaluation can be conducted after six months, incorporating medical history and physical examination. In 30–40% of cases classified as idiopathic male infertility, no identifiable male-related factor (such as comorbid conditions affecting fertility, abnormal physical examination findings, endocrine disorders, genetic abnormalities, or biochemical irregularities) is found to explain the deterioration in sperm parameters. Recent evidence suggests that idiopathic male infertility may be linked to previously unrecognized pathological factors, including environmental pollution, sperm DNA damage due to reactive oxygen species, and genetic or epigenetic abnormalities. Surgical treatments for male infertility vary depending on the underlying pathology. With advancements in technology and the integration of modern medical innovations into surgical interventions, several novel techniques have been developed. One of the most common etiological factors in male infertility is varicocele, which is currently treated predominantly through microsurgical varicocelectomy. Similarly, in men diagnosed with non-obstructive azoospermia (NOA), microsurgical testicular sperm extraction (micro-TESE) has become the standard surgical approach. Undoubtedly, with the rapid advancements in technology, new devices will continue to be incorporated into surgical interventions for male infertility, expanding the range of treatment options available to urologists. Keywords: varicocelectomy, tese, spermogram, pesa, mesa