15 percent of couples who want to have children, that is, approximately one in every 7 married couples, cannot have children even though they have had unprotected intercourse for at least a year.

What should be done for diagnosis in men who cannot have children?

The first test to be performed after the examination for male infertility is semen analysis (spermiogram). Normal spermiogram values:

Men with results above these values ​​are considered normal; However, couples with normal values ​​may also experience infertility whose cause cannot be determined. It cannot be said that men with sperm results below these values ​​cannot be fathers at all; it can only be said that their chances of becoming fathers through normal means are low.

What are the male-related diseases in couples who cannot have children?

Only male-related problems are found in one third of infertile couples. (Figure 1) The most common cause of male infertility is varicocele disease.

What is varicocele and how does it cause infertility?

Testicular veins are approximately 1-2mm thick. Varicocele is the dilation of testicular veins. After leaving the testicle, the testicular veins move upwards for approximately 20-30cm and open into the main vein of the body. The long distance traveled by the veins and the fact that they are against gravity make blood flow difficult. For this reason, in some men, the blood in the testicular veins cannot be carried upwards, and even the blood in the main vein may flow into the testicle, causing blood accumulation in the testicle. Pooling of blood in the testicle causes the temperature of the testicle to increase and waste materials that need to be removed from the testicle to accumulate in the testicle. This condition can cause testicular pain and infertility by disrupting sperm production.

How can varicocele be treated?

Unfortunately, varicocele disease cannot be treated with medication. The only treatment is surgery. By surgically tying off the enlarged veins, blood pooling in the testicle is prevented.

Why should varicocele surgery be performed under a microscope?

Since the arteries, lymph vessels and veins of the testicle are side by side and very thin, it is very difficult to distinguish these vessels from each other with the naked eye during surgery. If surgery is performed with the naked eye, the possibility of damage to the arteries and lymph vessels increases. In order to prevent this undesirable situation, the procedure should be performed under a microscope.

What is done in varicocele surgery?

The surgery is performed through a 3-4cm incision in the groin. After the incision is made, the area where the testicular vessels are located is reached and the enlarged veins are ligated under the microscope, preserving the arteries and lymph vessels. This surgery is called microscopic varicocelectomy. The success rate after varicocelectomy performed under a microscope is over 90 percent.

What are the most common causes of male infertility after varicocele?

The second most common cause is undescended testicle. In approximately one-third of patients, the cause of infertility cannot be determined.

What is azoospermia and what are the causes?

15 percent of infertile men have no sperm output, a condition called azoospermia. The most common cause of azoospermia is undescended testicle. This is followed by varicocele, blockage in sperm ducts, and genetic and hormonal disorders.

What are the treatment options for men with azoospermia?

It is not possible to treat causes other than varicocele and some conditions that cause blockage in the sperm duct. Although there is no sperm in the spermiogram in these patients, there may be a small amount of sperm production in some areas of the testicle. It is very difficult to detect these areas with the naked eye. (Figure 4 a) For this reason, the procedure should be performed under a microscope (micro TESE). With micro TESE surgery, areas in the testicles that are likely to produce sperm can be detected under a microscope and sperm can be found by taking tissue samples from these areas.If sperm is found, these sperm are used for in vitro fertilization (ICSI).